Page - 325 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

325How Should We Allocate Health and Social Resources During a Pandemic? safety net, millions took to the roads, often walking hundreds of kilometres to go home to their ancestral towns and villages. Public transportation had been shut down. Similar impacts on the poor were seen in some African countries. Moreover, in many low- and middle- income countries, police harassment and brutality increased as they sought to enforce lockdowns. Reports of violence against women and children also increased around the world.23 In low-income countries, adequate housing, access to clean water and toilets, household savings, and other COVID-19 prevention necessities are simply unavailable to millions of people. Moreover, unlike in high-income countries, COVID-19 is not the only epidemic to impact many low- and middle-income countries. There are ongoing epidemics of tuberculosis, malaria, Lassa fever, Ebola, and others. All of those programs were brought to a halt because of lockdowns. In fact, as in high-income countries, hospitals situated in low- and mid- dle-income countries have been converted into COVID-19 hospitals. The excess mortality in these countries is likely to be enormous, and many of the gains in infectious disease control are likely to be lost. The enormous devastation that has been caused, particularly in low- and middle-income countries, because of the application of the contain-and-control approach at a national scale have raised funda- mental questions about the one-size-fits-all approach implicit in sci- entific guidance. From here on in, it is likely that universal scientific guidance will not be applied without scrutiny when responding to the next waves or when dealing with other health issues. When applied to a small group of people or even to a region, additional burdens resulting from the contain-and-control approach seem justifiable; it benefits the greater good. But the appropriateness and effectiveness of the geometric scaling up to the national level have yet to be evaluated. This approach has created enormous harms to certain communities, as well as the population as a whole. In high-income countries, par- ticularly the United States, the enormous harm to economic activity has resulted great scepticism of scientific expertise, and even, its clear rejection by political leadership. 23. “Human Rights Dimensions of COVID-19 Response” (19 March 2020), online: Human  Rights  Watch <www.hrw.org/news/2020/03/19/human-rights- dimensions-covid-19-response>.