Rodela et al.

(2020) Economic Impacts of COVID-19: Working Paper Series

Economic Impacts of Coronavirus Disease (COVID-19) in Developing Countries

Tahmina Tasnim Rodela,1 Samia Tasnim,2 Hoimonty Mazumber,3 Farah Faizah,4

Abida Sultana,5 Md Mahbub Hossain*2

ABSTRACT

The coronavirus disease (COVID-19) has critically impacted global health systems and
economies, especially in developing countries. Those countries have been struggling to address
the preexisting burden of diseases with limited resources, which will become even more
challenging during COVID-19. The economic implications related to COVID-19 in those
countries include a high cost of care, market failures in pluralistic health systems, high out-of-
pocket expenses, the added burden of noncommunicable diseases, missed economic
opportunities, and socioeconomic consequences like unemployment and poverty. It is essential to
assess the prevalent gaps, mobilize resources, strengthen health systems financing and
leadership, enhance research capacities informing evidence-based policymaking, and foster
effective partnerships for addressing health and economic disparities due to COVID-19.

Keywords: Coronavirus; COVID-19; Communicable Diseases; Developing Countries; Health Economics

1
Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh.
2
School of Public Health, Texas A&M University, College Station, TX 77843, USA.
3
Ipas Bangladesh, Dhaka, Bangladesh.
4
United Nations Population Fund (UNFPA), Cox’s Bazar, Bangladesh.
5
Gazi Medical College, Khulna 09000, Bangladesh.
*Correspondence at: [email protected]

1
Introduction

The coronavirus disease 2019 (COVID-19) is one of the major global health events in the
twenty-first century, which has affected almost every nation globally [1]. Since
December 2019, this outbreak caused by a novel coronavirus was found to be structurally
related to the viruses that caused severe acute respiratory syndrome (SARS) and the
Middle East respiratory syndrome (MERS) [1]. During 2002-03, a total of 8,098 cases of
SARS were identified, of these 774 died [2]. The later outbreak by MERS infected 2,494
individuals, among which 858 died since 2012 [3]. However, COVID-19 has clearly
exceeded the earlier outbreaks of coronaviruses. As of April 2, 2020, more than a million
people from 181 countries are identified as COVID-19 cases, and more than 52,900
deaths are reported due to the disease [4].

With a growing incidence and case fatality attributable to COVID-19, health systems
around the world are experiencing critical challenges in terms of preventing disease
transmission, diagnosing new cases, providing care, and ensuring recovery [5]. These
challenges have heavily impacted many nations with high income and well-structured
health infrastructure, which informs how critically it may impact developing countries,
which have fragmented health systems with poor population health outcomes [6]. The
growing burden of COVID-19 necessitates an understanding of economic implications in
the contexts of developing countries to inform effective policymaking and practice during
this pandemic.

Economic challenges for the health systems in the developing countries

Historically, developing countries have suboptimal diagnostic capacities [7], which may
have resulted in a low number of COVID-19 cases during the earlier stages of this global
outbreak. However, a delayed diagnosis of COVID-19 may lead to hospitalization with a
need for critical care support [8]. Such tertiary-level services would cost higher than
preventing the disease at earlier stages. It is noteworthy that most healthcare
organizations
in developing countries lack critical care services, which implies that the increased
demand for intensive care units or ventilators to stabilize COVID-19 patients may remain
unmet.

In developing countries with a lack of universal health coverage, where the market plays
a dominant role, the cost of care would also depend on the elasticity of health services
and commodities in those contexts [9]. Such economic failures may happen for diverse
health services during managing COVID-19 in institutional settings. Moreover, continued
shifting of health workforce and resources will create critical distributive issues as
patients with other health problems may not receive their designated services during this
pandemic. Therefore, health systems in LMICs that are often under-resourced and over-
burdened are likely to incur a high cost of care and associated economic failures while
addressing COVID-19.

Another major economic challenge during COVID-19 would be a high out-of-pocket

(OOP) expenditure in developing countries. Most of those nations healthcare
organizations operate within pluralistic health systems incurring OOP for health services
[10]. This economic burden is likely to increase during COVID-19 unless state-sponsored
diagnostic and therapeutic financing is made available. An increased OOP is associated
with subsequent poverty, unemployment, and other socioeconomic consequences, which
may affect individuals and populations in the post-COVID-19 era.

Furthermore, many developing countries already have a high burden of comorbid

noncommunicable diseases (NCDs) [11], which may increase the hospitalization and
mortality across populations while cooccurring with COVID-19. From an economic
perspective, such adverse health outcomes will affect the economic returns on existing
and newly adopted strategies of health systems financing. In addition, many people with
NCDs may experience restricted mobility due to lockdown or lack of transportation,
which will affect their access to health services during COVID-19 [12].

The economic consequences of such missed health opportunities will affect developing
countries, whereas people living in quarantine or lockdown will have an added risk of
developing NCDs, which may have prolonged economic implications for respective
health systems. Other economic challenges associated with COVID-19 in developing
countries may include but not limit into lost wages and insurance benefits of hospitalized
individuals, suboptimal use of health services which could have been generated
institutional and societal benefits otherwise, and disability-adjusted life years (DALYs)
attributable to COVID-19 in those countries [13].

Recommendations for health policymaking and practice

These implications should be acknowledged across developing countries to address the

ongoing and forthcoming economic challenges. As the determinants of health economics
would be different for each context, the developing countries should devise rapid
situational assessment to understand potential economic issues associated with COVID-
19. Since most of those countries have a poor allocation of resources for health, it is
essential to evaluate the available resources and mobilize the same ensure ensuring cost-
efficiency. Perhaps, balancing between preventive measures and establishing low-cost
tertiary management may alleviate the burden of COVID-19 with a minimal economic
burden.

Further, it is necessary to strengthen the primary care and referral services so that
population health can be served without disrupting existing models of delivering health
services. In addition, special attention should be given to elderly adults and other
vulnerable groups addressing the specific health needs of those populations [12]. In
addition, telemedicine services can be used to ensure appropriate health communication
on COVID-19 [14]. However, such approaches may need advanced infrastructure, which
may not be readily available in developing countries. Therefore, it would be essential to
use the existing resources and develop innovative strategies that can provide cost-
effective health services without affecting the ever-shrinking economy during COVID-
19.
Economic challenges often lead to socioeconomic disparities, which should be analyzed
from health and social perspective. Developing countries may adopt policies and
programs to minimize health disparities and their consequences, which would necessitate
strong leadership efforts at institutional and national levels. It would be difficult to
address structural barriers without such efforts with a long-term vision. Despite the
scarcity of resources, many developing countries have shown promising success in
addressing population health problems in the past, which highlight the role of public
health leadership. Nonetheless, the severity of public health emergencies may need
collaborative efforts among different agencies, which may allow them to utilize shared
resources and maximize health and socioeconomic benefits following such
collaborations. Large scale outbreaks like COVID-19 may impact the psychosocial
wellbeing among populations, which would be hard to measure and manage, especially in
developing contexts. Therefore, health and economic research should be prioritized in
those countries with regional and global collaborations [15]. Furthermore, a lack of
context-specific evidence may affect the development and implementation of health and
economic policies. This gap informs a need for enhancing research capacities in
developing countries for preventing upcoming crises and building resiliency across health
systems in those.

Conclusion

COVID-19 is affecting global populations indiscriminately; however, the burden of

disease and economic consequences can be much greater, potentially under-reported, and
under- estimated in the developing countries who share a major proportion of the global
burden of diseases without adequate preparedness in their health systems. This gap
between health problems and abilities to address the same is common across those
contexts resulting in adverse economic impacts in a vicious way. Such widespread
disparities necessitate multilevel policies and context-specific strategic approaches,
ensuring optimal care in COVID-19 minimizing economic challenges in the developing
countries.
Conflicts of interest: The authors declare no conflicts of interests.
Funding: No funding was received at any stage of preparing this
manuscript. Acknowledgement: None.

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