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COVID-19: the rude awakening for the political elite in low- and middle-income countries
  1. A M Viens,
  2. Oghenowede Eyawo
  1. School of Global Health, York University, Toronto, Ontario, Canada
  1. Correspondence to Dr A M Viens; amviens{at}

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Summary Box

  • Decades of bad political choices by the elite class has resulted in weakened health systems in many low- and middle-income countries

  • The resulting lack of high-quality care and poor health outcomes are typically only borne by those of lower socio-economic standing - with the elites and their families being able to seek care in high-income countries.

  • COVID-19 may change all that—a highly transmissible virus and restrictive measures that prevent elites from flying abroad has forced them to depend on an ill-equipped health system at home.

  • COVID-19 presents a stark illustration that we are all interconnected; social class, personal status or borders do not help to evade health vulnerability.

  • Enlightened self-interest of political elites may finally provide sufficient motivation to invest in an effective and integrated health system.

Political choices determine the conditions under which people can be healthy, including how COVID-19 spreads and its impact on populations. Decades of political corruption1 and the permeation of neoliberal political ideology2 have left health systems, especially in low- and middle-income countries (LMICs), chronically underfunded, insufficiently regulated, inadequately staffed and unable to deliver high-quality care.3–5 The resulting consequences are poor health outcomes, financial waste, increasing inequality, disproportionate share of global disease burden and immeasurable human suffering—especially for the most disadvantaged and …

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