The coronavirus pandemic will have a greater impact on the world’s most disadvantaged and vulnerable populations, according to an Imperial report.

The analysis focused on lower-income and lower-middle-income countries (LMICs) and found that the risk of death from COVID-19 increases dramatically with increasing poverty within LMICs.

The 22nd report from the WHO Collaborating Centre for Infectious Disease Modelling within the MRC Centre for Global Infectious Disease Analysis, the Jameel Institute (J-IDEA), Imperial College London, presents an analysis of the likely inequitable impact that COVID-19 disease and its response will have on the world’s most disadvantaged and vulnerable populations.

Health inequities

Within LMICs there are unfair or avoidable differences in health among different groups in society – health inequities – that mean that some groups are particularly at risk from the negative direct and indirect consequences of COVID-19.

The researchers considered how handwashing access, occupation and hospital access varies with respect to wealth status and used mathematical models to understand the impact of these differences on health outcomes.

They estimate a 32% increase in the probability of death in the poorest fifth of the population compared to the wealthiest fifth from these three factors alone.

The researchers explain that the least well-off tend to live in larger, inter-generational households, which in turn may hamper efforts to protect the elderly with social distancing measures.

Food-security issues

Poorer populations are also more susceptible to food security issues - with these populations having the highest levels of under-nourishment whilst also being most dependent on their own food production.

The researchers warned that the timing of the COVID-19 epidemic in low-resource settings also has the potential to interrupt planting and harvesting seasons for staple crops, thereby accentuating this vulnerability.

Refugees and internally displaced people are especially vulnerable to the impact of COVID-19 and face the additional challenges of fragile or non-existent health systems and poor infrastructure, according to the research team.

'Disadvantaged particularly at risk'

Three authors of the report, all from Imperial's School of Public Health, share their concerns:

Dr Peter Winskill, said: “Disadvantaged and vulnerable populations are particularly at risk from the direct and indirect impacts of COVID-19. To maximise health and well-being for all it is vital to consider equity in the response to the pandemic.”

Charlie Whittaker, said: “These results highlight that both the direct and indirect impacts of COVID-19 are likely to be borne by the most vulnerable within society. Supporting these impoverished groups as the pandemic progresses will be essential if substantial loss of life is to be avoided.”

Dr Patrick Walker, said: “Existing underlying patterns of global inequity will mean that poorest members of societies have consistently fewer available options to protect themselves from being infected, to access care if they get sick and, even if they do successfully shield themselves from infection, will suffer more from the indirect consequences of the pandemic."