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Elites can take care of themselves — Comment on COVID-19: the rude awakening for the political elite in low-income and middle-income countries
  1. Irene Torres1,
  2. Daniel F López-Cevallos2,
  3. Fernando Sacoto3
  1. 1Fundacion Octaedro, Quito, Ecuador
  2. 2School of Language, Culture, and Society, Oregon State University, Corvallis, Oregon, USA
  3. 3Ecuadorian Society of Public Health, Quito, Ecuador
  1. Correspondence to Dr Irene Torres; irene{at}

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  • The COVID-19 pandemic has exacerbated pre-existing inequities in low-income and middle-income countries without robust universal health coverage, placing marginalised and vulnerable populations at higher risk.

  • Access to healthcare has been limited in Ecuador, where more than 8000 excess deaths were registered in April, while supplies and services are available through private insurance or out-of-pocket payments.

  • Political and economic elites may also avoid restrictions and profit from the emergency, making evident that vulnerability to the disease cannot be reduced to biological risk.

  • We must continue to make the case for responsible health governance and a greater share of financing by the elites for universal primary care to be accessible regardless of ability to pay.

Political and economic forces, both internal and external to low-income and middle-income countries (LMICs), have shaped the health and well-being of people across much of the Global South. Like in other regions of the world, corruption for private gain, including in health systems, has impeded the development of a welfare state and has thus cost lives in Latin America.1 It may be true that political (and we add economic) elites have the ability to receive the best possible care outside their countries, nevertheless, COVID-19 has definitely not diminished privileges locally.2 In fact, while they would previously seek high-end medical attention in the USA or Spain, today, in countries such as Ecuador, these elites might be just as catered for at home. Even in the midst of the pandemic, they are able to secure medical resources that are not available for everyone, for instance, through private health or prepaid care insurance companies offering a range of services from basic to five-star’ services, depending on the customer’s ability to pay.

After the major port province, Guayas, became the first COVID-19 epicentre in Ecuador in mid-March, it was …

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