The extent and severity to which the COVID-19 coronavirus pandemic will impact the fight to end extreme poverty is still unknown, but it is expected that the crisis will devastate the world’s most vulnerable people.  

The virus is already disproportionately impacting the poor in wealthy countries, where the most known cases are concentrated. Experts are urging the world to prepare to lend extra support to low-income countries to address the pandemic. 

COVID-19 cases are more likely to go undetected or to be under-detected in developing countries that have fewer resources available to tackle a pandemic. Countries with large poor populations including Brazil, India, Indonesia, Nigeria, and Pakistan have confirmed few cases, but have been slow to respond to the threat, according to NPR.

Smaller developing countries where health care systems are weak rely on support from the international community and cannot combat the virus alone. The United States pledged additional foreign aid to help at-risk countries address COVID-19, but put a hold on sending them supplies on April 1, raising concerns.

Dr. Natalia Linos, executive director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University, said the world needs to have a social conversation around how COVID-19 impacts inequality and poverty. If not, it will be challenging to achieve the United Nations’ Global Goals by 2030. 

"Unless governments do something explicitly to focus on the poor, we would be silly to think that that wouldn't impact achieving goal one — solidarity and global commitment to fight poverty — which I think already is going to require a lot," Linos told Global Citizen. "Now there's this additional challenge."

"For high income and middle-income countries, where the health care systems are strong enough, then you need explicit pro-poor policies," she added.

Linos points out five ways that poverty and COVID-19 intersect as the world celebrates World Health Day on Tuesday.

1. Lower-income people are more at risk of disease.

"What we know from many diseases, not just this one, is that poverty increases your risk of exposure," Linos said.

Preventative care and health education are less accessible to low-income people who are more likely to have pre-existing conditions, catch COVID-19, and die from it. People living in poverty are also more likely to hold insecure jobs and cannot afford to stay home sick from work.

Countries are enforcing lockdowns to promote social distancing and contain the virus, but such precautions are more challenging in developing countries, like India, with crowded cities and slums. People living in small, confined spaces with multiple people are not able to isolate themselves as easily to help contain the virus. 

"If you're telling people who live in slums that they need to wash their hands, but you don't have running water — they don't have soap — then you're really not doing something," Linos said. "The response isn't poverty sensitive. It's not understanding what the limitations are."

2. Vulnerable communities have unequal access to health care.

Around 4 billion people — half the world’s population — lack access to health care. Illness is especially expensive for poor people. Health care costs push nearly 100 million people into extreme poverty.  

Even wealthy countries are struggling to control the COVID-19 outbreak and are experiencing shortages of tests, protective equipment for health care workers, and hospital beds. Developing countries are expected to have an even harder time meeting the demand if they experience an outbreak.

"What is going to happen in Somalia? What is going to happen in Yemen, when you're also dealing with a humanitarian crisis?" Linos said. "The preparation there really, really requires some of the expertise from other places, whether it's us [the US] now, China, or others stepping up to support those countries, otherwise, we're not only going to miss meeting SDG [Sustainable Development Goal] one but many, many, many of the goals."

3. People living in marginalized communities lack protection.

"The groups that we think risk being sort of left behind in the response are homeless, refugees, or immigrants who are undocumented or feel that they have fear to be part of the system," said Linos, who also supports the #PoorPeoplesCampaign, an organization that aims to protect marginalized communities in the US.

Accessing health care and preventative services like proper handwashing and sanitation facilities are especially difficult for refugees, migrants, or internally displaced communities around the world. COVID-19 could potentially spread rapidly in refugee camps, shelters, or in slums and people living in these conditions would be less likely to have the resources to fight off the disease.

4. Access to reproductive health care is more limited during crises.

"If you can't do family planning, there could be trickle-down effects that are felt," Linos said.

Providing contraception access is one of the simplest ways to reduce poverty, but 232 million women who want to avoid pregnancy are not using safe and effective family planning methods.

Evidence from previous epidemics suggests disease outbreaks significantly limit availability to reproductive health care and family planning while resources are diverted to address the crisis. 

Without adequate resources and information to choose when and if to have a baby, women cannot make the important decisions to plan their futures. Mothers who have unplanned pregnancies tend to give birth when they’re younger, not finish their education, and earn less income later in life.

5. Job instability perpetuates poverty.

The world’s poorest people hold insecure jobs, with little protection, in unsafe conditions, and lack access to health care.

"For people who are not necessarily going to be in the hospital, but are going to be unable to work for two weeks or three weeks, that could mean that they're pushed into poverty because they may lose their job," Linos said. "Or if they're informal workers, may not be able to recover within a month or two months, and then that employment may not be available."

People living in poverty who survive COVID-19 — but miss work due to quarantines or other measurements — are also likely to lose health care employment benefits.

East Asia Pacific in the time of #COVID19: Easing credit, if regulated well, can help vulnerable households and firms survive the immediate crisis period: https://t.co/N3ym46V9wD#EAPUpdate

— World Bank (@WorldBank) April 2, 2020

Women, who make up the majority of the informal workforce, are being forced to continue working and put themselves at risk, or give up their livelihood to take on more unpaid household and child care responsibilities, Linos said.

Coronavirus will stop almost 24 million people from escaping poverty in East Asia and the Pacific, the World Bank predicted in a report released on March 31. Low-income people in the region depend on industries vulnerable to the financial impact of the virus, like tourism and manufacturing.

Disease outbreaks and poverty are a vicious cycle — widespread declining economic status leads to more disease, which leads to more poverty. Epidemics worsen inequality and raise the cost of living, making it more difficult to get by.