This document discusses priorities for low- and middle-income countries (LMICs) during the COVID-19 pandemic. It notes that both high-income countries (HICs) and LMICs face high infection risks from COVID-19, though LMICs may be disproportionately affected due to large proportions of populations living in poverty. It emphasizes that correct risk communication is key to shaping behaviors to reduce transmission in LMICs and that financial assistance for the poor is urgently needed to allow for social distancing without worsening economic hardship. References are provided on factors influencing COVID-19 transmission and the likely severe economic impacts on LMICs.

1. COVID19: Priorities for low- and middle-income countries
Elisa Sicuri,
Barcelona Institute for Global Health (ISGlobal)
Imperial College London
Celine Aerts,
ISGlobal
Simple reflections and hypotheses on the economics of
COVID19 in low- and middle-income countries
El día después será: Environment and health: ‘’The year after’’, 04/05/2020

2. COVID19: Priorities for low- and middle-income countries
- Even if consequences for LMIC can be much worse, both HIC and LMIC
share a common situation relative to COVID19:
- High risk of infection
- There is no vaccine, no treatment, high proportion of severe cases,
quite high mortality
- There is not yet clear evidence on this, however, both COVID19 and
the public health measures to avoid infection transmission are
disproportionally affecting the poorest, where “the poor” are a huge
proportion of the population in LMIC

3. Behaviour
Mask wearing
Hand washing
Social distancing
COVID19: Priorities for low- and middle-income countries
Risk perceptionKnowledge
Income/Wealth “Place” Sex Education
Ref: Qiu et al, 2020; Briscese et al, 2020; Dave et al, 2020; Barrios et al, 2020; Zachary et al, 2020

4. Malaria
Dengue fever
Zika virus
Cutaneous leishmaniasis
COVID19: Priorities for low- and middle-income countries
We attempted to analyse such a complexity in a recent study in Guyana, South
America, for the following infectious diseases (vector-borne):
Ref: Aerts et al. 2020

5. A structural equation model (SEM)
COVID19: Priorities for low- and middle-income countries

6. Behaviour
Bed nets
IRS
Fogging
Repellents
Coils
Screened windows
COVID19: Priorities for low- and middle-income countries
Risk perceptionKnowledge
Income/Wealth “Place” Sex Education
Refs: Aerts et al., 2020
Malaria
Dengue
Zika
Leishmaniasis

7. COVID19: Priorities for low- and middle-income countries
Behaviour directly affected by:
✓ Knowledge
✓ Risk perception
✓ Wealth
✓ Region
Indirectly:
✓ Region (affects both risk and knowledge)
✓ Education (affects knowledge)
✓ Wealth (affects risk)
✓ Behaviour in turn decreases risk perception
➔ Evidence of a bidirectional link between risk perception and behavior
Policy recommendations towards the good behaviour:
- Correct communication is key to improve knowledge and shape risk perception,
therefore, promote the right behaviour
- Free of charge interventions, subsidies, loans, etc are needed for the poor

8. Behaviour
Mask wearing
Hand washing
COVID19: Priorities for low- and middle-income countries
Risk perceptionKnowledge
Income/Wealth “Place” Sex Education
How can this study apply to the context of COVID19?
✓ RIGHT communication is likely to be key to feed knowledge and risk behaviour
✓ Free of charge interventions (free masks, gloves, treatment, vaccine) are needed for the
majority of the population
✓ HOWEVER …
Social distancing
Without immediate finacial help to the poorest on top
of free of charge interventions, a very negative loop will
start “social distance – income loss – more COVID19”

9. COVID19: Priorities for low- and middle-income countries
What is the likely economic situation in LMIC due to COVID19?
Direct impact:
- From job loss to hunger:
'We'll starve to death if this continues'
Indirect impact:
- COVID-19 burden higher among some ethnic minorities:
Black African deaths three times higher than white Britons
- The economic impact of European COVID-19 to Africa:
Coronavirus: How Covid-19 is affecting remittances to Africa
What to do in the short term?
- Activating any type of safety net: cash transfers, sick leave, subsidise healthcare, etc:
Strengthen the safety net
Ref: Platt et al, 2020.

10. COVID19: Priorities for low- and middle-income countries
References (there is very little to date on LMIC)
- Qiu, Y., Chen, X., Shi., X. (2020). Impacts of Social and Economic Factors on the Transmission of
Coronavirus Disease 2019 (COVID-19) in China, IZA DP No. 13165
- Briscese, G., Lacetera, N., Macis, M., Tonin M., (2020). Compliance with COVID-19 Social-
Distancing Measures in Italy: The Role of Expectations and Duration, NBER Working Paper No.
26916
- Dave, MD., Dench, DL., Kenkel, DS., Mathios, AD., Wang, H., (2020). News that Takes Your
Breath Away: Risk Perceptions During an Outbreak of Vaping-related Lung Injuries, NBER
Working Paper No. 26977
- Barrios, JM., Hochberg, Y., (2020). Risk Perception Through the Lens of Politics in the Time of
the COVID-19 Pandemic, NBER Working Paper No. 27008
- Zachary A. Bethune and Anton Korinek, (2020). Covid-19 Infection Externalities: Trading Off
Lives vs. Livelihoods, NBER Working Paper No. 27009
- Sumner, A., Hoy, C., Ortiz-Juarez, E., (2020). Estimates of the impact of COVID-19 on global
poverty, WIDER Working Paper 2020/43
- Aerts, C., Revilla, M., Duval, L., Paaijmans, K., Chandrabose, J., Cox, H., & Sicuri, E. (2020).
Understanding the role of disease knowledge and risk perception in shaping preventive
behavior for selected vector-borne diseases in Guyana. PLoS neglected tropical
diseases, 14(4), e0008149.
- Platt, L., Warwick, R., (2020). Are some ethnic groups more vulnerable to COVID-19 than
others?, The Institute for Fiscal Studies – Deaton Review.