The 20th century debate on appropriate technology as aid to the global south was eventually won by those who saw the reason in refusing to plan development around the wholesale use of large-scale western techniques. Today, right now, the discourse on aid to the poor nations of our world in their coming fight towards management of Covid 19 still tends to be Western-centred.
Yet it now seems clear enough that aid and knowledge from East Asia is of the essence. Large amounts of resources flowing from the West – inevitably mixed with advice and persuasions that go well beyond equipment and medicines – directed at inappropriate institutional arrangements or procedures may be mis-spent, however well-meant. Any aid, however, that recognises differences in circumstance as well as relative failure of the western mode of virus policy, should be very welcome.
How far does money matter in poor nations? The Western model says it should, for in Europe and the USA much has been made of the cost of lockdown, closing schools and large public utilities and services, and of increasing the capacity of health care. Such features should have a definite impact on the concerns of most European governments and of the USA. The mortality rate, other things being equal, should be lower in richer nations.
To date, the more reliable measurements are showing that East Asia was not only earliest as a location as well as manager of the virus, its subsequent record is far better than that of the West. Even with the recent announcement from China that it has understated its mortality from Covid 19, the overall mortality rate of East Asia (measured here as identified deaths as a ratio of identified total cases), is far lower than that of the West. In gross terms, today (27 May) with a world ratio of 6.2% , that of Europe lies around 9% , that of North America 5.9% % that of Asia 2.8%. East Asia without China has a ratio around 2%.
The best of East Asia is still doing very well indeed, and even China must be given great credit for acting quickly from an epicentre that included huge density, massive numbers of constantly traversing small businesses, huge volumes of commercial communication between the region and others, as well as an onset that coincided with the Chinese New Year fortnight holiday period. If we add the population of around 1.5 billion it is hard to deny that Chinese mortality seems low.
When we turn to the western core of the virus (the USA, UK, Spain, Italy, France and Germany), with a combined population about one fifth that of the East Asian, then the number of cases – 2.875,865 – yields a mortality ratio standing at 8.2% and rising, but with the hot-spot average ratio of deaths to cases in Spain, Italy and France being 14-16%, this incorporating approximately 40% or more of the world’s total mortality from the virus.
Yet the wealth of the western core when compared to that of East Asia is roughly equivalent, based on the World Bank’s purchasing power parity measures normally used for international rankings.
Admitting that all quantities at present being used in relation to the virus are highly problematic, we can hazard that the West generally is not a prime exemplar of good virus management if we are prepared to accept that the mortality rate so defined is of especial interest.
We think that the mortality rate is of importance because it incorporates not simply the luck in borders (and border control), location, climate and demography that might be determining numbers of infections between nations, but also the deaths that are more likely determined by such factors as length of time, early identification of networks of infection through testing, early intervention in social distancing, and hospitalisation and treatment of the vulnerable, etc. In other words, whilst the numbers of infected might at present be attributed to any number of extrinsic factors, the mortality rate is more likely to be a complex outcome of identification, movement of resources to crisis sites, and social management processes.
The latter may all be improved by funding and, so, by aid from any source. Here we are suggesting that the evidence shows that abundance of wealth and knowledge is not sufficient to produce sound management. Indeed, it now seems to be the case that expensive lockdowns of nations, their homes, schools and industries, is not central to the business of virus management. East Asia’s record is very good but with minimum use of total lockdown compared with the USA and Europe.
It is also clear that it is not by any means too late for Africa, the Middle East, South America, and South Asia to actively choose models for action that do not entail massive economic costs and social dislocations. Even the gross figures show that mortality rates in these groups of nations are relatively small, standing at around 2.8% for all Asia, 4.0% for South America and 5.2 for Africa. This indicates well how the virus is in its early stages in these huge regions of our world, where not enough time has yet lapsed from first coteries of the disease to large numbers of deaths.
So, an inevitable case seems to mount that in the very short period in which decisions must be made – with no wriggle room for malingering over either political economy or technical niceties – the poorer nations on the threshold of what might be virus disaster should develop firm strategies around an alternative virus technology of identification, testing, intervention into networks and known sites of disease and early medical care of the vulnerable. This downplays grand lockdown in accordance with our general argument. But this ‘East Asia’ conclusion is hastened by other obvious factors.
An immediate reaction amongst a mass of people in poor nations is – and shall be – relocation of underemployed workers and their families from cities to the country regions from which they came, often a generation or so ago. This is seen now in South Asia and it will surely become prominent in Africa. This makes much sense. Villages and townships will often have great respect for their elders and those vulnerable to the virus. Aid which centres on large hospitals in densely crowded cities is not by any means worthless, but it will miss many, and in particular it is likely to have less impact on the mortality rates as defined here.
Supplying the right sites with testing equipment, proper protective clothing, ventilators, medicines and drugs and so on is expensive in institutional commitment and social acquiescence, but cheap in final expenditures on facilities and infrastructure. Aid in basic transportation including good trucking into less dense country areas, in production of ventilators and oxygen-supplied beds, and in communications has strong elements of high- tech without requiring huge capital expenditures. Advice and training on hygiene and patient handling does not require a phalanx of scientists in every place. Auxiliaries and nurses are of more importance than doctors and administrators. The science of the vaccine will come later, sometime after the initial waves of virus dislocate the lives of the global poor.
Much depends on social mobilisation and faith in community. East Asia has shown the value of cultural and embedded institutional mores in securing efficient organisation and widespread compliance. Degrees of democracy probably matters less than social cohesion based on underlying community values. The West has been full of disabling quarrels and covert tensions between governance and people, ‘following the science’ has too often led to dissention and confusion, at times stasis.
There is no suggestion here that an alternative, flatter management of the virus will secure plain sailing. Quite the opposite. The poor world is just too often geographically sited in climates of disease and terrains of extremely difficult transport and communication. Frontiers are often war zones. But to transfer into all of that a flow of aid that is expensive and perhaps inappropriate will merely disguise the underlying realities. At the same time, the UN and even the WHO are not yet showing clear guidance not yet sending much in the way of real equipment into precisely targeted emergencies.
A better or at least complementary approach is for the poor, southern part of the globe to parley with East Asia, particularly with China, Japan, South Korea and Taiwan to secure basic supplies and expertise, even personnel, into their nations as soon as possible. Voiced by powerful diplomatic interests, there are compelling economic reasons for the East to listen and act. If this becomes a true vanguard of a more global process, increasingly funded by the West, then that can only be a good thing. But action is certainly needed right now. Let there be no doubt about that.
Professor Ian Inkster, School of Oriental and African Studies, University of London, is a global historian and political economist who has taught and researched at universities in Britain, Australia, Taiwan and Japan. Author of 13 books on Asian and global dynamics with particular focus on industrial and technological development, and the editor of History of Technology since 2000. You can findhim on Twitter at inksterian.