he coronavirus pandemic has overwhelmed health systems in Europe and North America. The US, France, Italy, Spain and the UK have all experienced shortages of doctors, ventilators, personal protective equipment and testing capacity. But it’s going to be even worse in poor countries where medical resources are scarce. Ten African countries have no ventilators at all. In Uganda, there are only 55 intensive care beds for 43 million citizens. And no poor country could afford the economic safety net that is currently sustaining citizens and companies here in the UK. In fact, Covid-19 is the biggest disaster for developing nations in our lifetime. If ever there was a time for concerned citizens and political leaders in both developing and richer countries to come together, it’s now. We’ve already seen that Covid-19 is no “great leveller”. Poorer people are at greater risk of catching the virus and are more likely to suffer the worst effects of an economic shock. And the poorer the country, the less capable it is of addressing people’s pressing needs, from identifying and treating cases of the virus to supporting communities and businesses deprived of income. The vast majority of people living in countries in sub-Saharan Africa are employed in the informal sector and receive no unemployment, sickness or other benefits. And more than a third of all jobs and incomes in Africa could be lost as a result of Covid-19. The World Health Organization has recommended physical distancing to control the spread of the virus, but in places where families share single-room homes and lack running water to wash their hands, these measures are difficult, if not impossible, to adopt. Many of the world’s poor have no access to life-saving medical facilities; in the entire African continent, there are just 20,000 critical care beds, equivalent to 1.7 for every 100,000 people. Malawi has just 25 ICU beds for its 17 million citizens, while in Bangladesh there are just 1,100 ICU beds for a population of more than 160 million. And while the UK health budget is $4,000 per citizen per year, in African countries it averages $12, according to the Organisation for Economic Cooperation and Development. In China and much of Europe, the coronavirus crisis precedes an economic crisis. But in many developing nations the economic shock has come first, as governments have locked down their economies to reduce the speed of contagion. As a result, countries in Africa and Latin America, together with Pakistan, India and Bangladesh, are expected to suffer their greatest ever economic decline. One immediate effect of the lockdown is hunger, as transport and distribution systems are severely disrupted and the food supply in many countries – already depleted after years of drought, extreme weather events and recent locust infestations – becomes scarce. Then there is the question of how countries will cope with the coming medical emergency. In South Africa, for example, it is expected that the pandemic peak will only be reached in September, but incomes have already shrunk due to a lockdown that was announced before the UK’s and is every bit as stringent as that in Italy. South Africa has mobilised domestically, working with civic organisations and businesses to create a solidarity fund to address the food and other needs of citizens, and reached out globally. However, even for one of Africa’s richest countries, this may be inadequate to address the scale of the challenge. Many leaders are doing all they can under the circumstances, but both domestic and international action is required to limit the damage caused by Covid-19. South African president Cyril Ramaphosa’s evidence- and equity-based approach stands in stark contrast with Jair Bolsonaro’s denialism in Brazil, or Donald Trump’s divisive actions in the US. But, while Covid-19 is a test of leadership everywhere, in countries with widespread and deep poverty where medical supplies are severely limited, even the best leaders cannot save their populations from health and economic vulnerabilities. Foreign assistance is essential. While rich countries can issue more debt in their own currencies, developing countries require foreign exchange to pay for much-needed imports, from lightbulbs to syringes. The cost of foreign debt repayments and imports have soared as the relative value of currencies in developing countries have declined by around 25%. Meanwhile, government revenues have plummeted due to a collapse in tax, tourism and migrant remittances as a result of the pandemic. Many cash-strapped governments can’t adequately provide for their citizens’ needs in normal times, let alone meet an unprecedented global emergency like this. The resulting cuts in other health areas, such as HIV therapies, and malaria- or cholera-eradication programmes, pose at least as big a risk to communities as Covid-19. International support has been lacking precisely when it is most needed. The US has turned its back on the world. The UK, like Europe, appears preoccupied with its own medical and economic emergencies; the ability of Commonwealth countries to cope with the pandemic appears to have fallen off its domestic agenda. Defeating Covid-19 and preventing future outbreaks around the world can only happen through cooperation. We need a global Marshall plan that would write off the $44bn in debt due by African countries in 2020 (an amount that is tiny compared to the $8tn that US and European governments have committed to keeping their businesses alive), and give at least $2.5tn in aid to poor countries, with a single condition: that it is used to alleviate the impact of the pandemic and to write off significant amounts of debt. This support, equivalent to barely 3% of global income, is essential not only to prevent the derailing of agreed UN development and climate goals, but to ensure that Covid-19 is not allowed to continue to spread. If there is one lesson Covid-19 has taught us, it is how interconnected our lives are. What I have called “the butterfly defect” of globalisation means that systemic risks anywhere are a risk to us all. We are only as strong as our weakest links. In the case of Covid-19, if one country is a pandemic hotspot, we’re all at risk of reinfection. Now more than ever we must show solidarity with those beyond our borders. Our health depends on the health of others. If we are to look forward to a better future, people elsewhere must too. • Ian Goldin is professor of globalisation and development at Oxford University and author of Age of Discovery, Development and Terra Incognita