Page - 520 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE520 While the U.S. has about 33 intensive care unit (ICU) beds per 100,000 population, the ratio is around 2 per 100,000 in India, Pakistan, and Bangladesh in South Asia. In sub-Saharan Africa, the situation is even more dire: Zambia has 0.6 ICU beds per 100,000, Gambia 0.4, and Uganda 0.1.12 Total ICU beds in 43 of Africa’s 55 countries are less than 5,000, or about 5 beds per million, compared with about 4,000 per mil- lion in Europe. There are also serious respirator shortages in Africa, with 10 countries having none.13 The average low-income country has 0.2 physicians and 1.0 nurse per thousand people, compared to 3.0 and 8.8 respectively in high-income countries.14 As high-income countries scramble to secure crucial supplies such as face masks, with increasingly strident calls to ban their export, nationalize equipment producers, and invest in this sector, low- income countries face much tougher choices. Their budgets are far more limited, and they typically lack local producers for most equip- ment, relying on donors and multilateral organizations for procure- ment in the face of unreliable supply chains. The looming COVID-19 threat to frontline health workers in low-income countries has been largely ignored. Only a frac- tion of needed PPE has gone to them. The WHO has dispatched 0.5 million PPE sets, while UNICEF has dispatched 100,000 N95 masks, 4.3 million gloves, and other PPE. Billionaire philanthropist Jack Ma has donated 100,000 masks and 1,000 protective suits each to every country in Africa as well as 1.8 million masks to 10 Asian countries.15 In recent decades, developed economies, through the International Monetary Fund (IMF) and World Bank, used aid con- ditionalities to demand funding cuts and neoliberal health sector reforms, for example, by imposing user fees in developing countries.16 Instead of improving efficiency, quality, and coverage, these reforms had deleterious implications for public health, besides exacerbating 12. Malley & Malley, supra note 8. 13. Ruth Maclean & Simon Marks, “10 African Countries Have No Ventilators”, The New York Times (20 April 2020), online: <https://www.nytimes.com/2020/04/18/ world/africa/africa-coronavirus-ventilators.html>. 14. Gage & Bauhoff, supra 11. 15. Ibid. 16. John Lister & Ronald Labonté, “Globalization and Health System Change” in Ronald Labonté et al, eds, Globalization  and  Health:  Pathways,  Evidence  and  Policy (New York: Routledge, 2009) at 181.