Editorial Notes

[Editorial Notes] The COVID-19 paradox in South Asia

It is surprising that South Asia has far fewer infections and deaths compared with North America and Western Europe.
By IASToppers
April 24, 2020


  • Introduction
  • Why South Asia has less infection and death than Western countries?
  • A possible hypothesis
  • Impact of lockdowns on Lives and livelihoods
  • Conclusion

The COVID-19 paradox in South Asia

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  • Income per capita in South Asia is just 16% that of the world, and a mere 4% of that in industrialised countries. 
  • One-third of the world’s poor live in South Asia, so absolute poverty is high and nutrition levels are low.
  • Population density in the subcontinent is among the highest in the world.
  • The poor, who live cheek by jowl in urban slums and in cramped spaces in rural areas, are most susceptible to a virus that is contagious. Public health systems and facilities are perhaps the worst in the world.
  • In spite of such situation, compared with North America, Western Europe and East Asia, or their own population size, the number of infection.

Why South Asia has less infection and death than Western countries?

 Past experience of the Spanish influenza in 1918, when India accounted for 18-20 million of the estimated 50 million deaths in the world would have led to the opposite conclusion.

There are two possible explanations:

Not enough testing

  • First, the total number of infections in south Asia is almost certainly underestimated, as testing has been nowhere near enough, given the scarcity of testing kits and the massive size of populations.


  • Second, the lockdowns imposed by governments in India, Bangladesh, Pakistan, Sri Lanka and Nepal, have clearly made a difference.
  • The lockdown in India is perhaps among the most stringent in the world. The common purpose was to break the chain of transmission through physical distancing, which has two dimensions.
  • For one, it confined people to their homes. But this created physical distancing only for the privileged living in homes that have spaces and doors. It was impossible for migrant workers where they lived in cramped spaces.
  • For another, it meant that people could not move within cities or across States. It did strangle potential chains of community transmission, reducing the geographical spread of the virus through contagion, and flattening the curve.

A possible hypothesis

However, other countries which have imposed lockdowns, say in Western Europe, with public health systems that are far superior, have not managed to slow down the spread in the number of infections as much.

  • It has been suggested that countries which have mandatory BCG vaccinations against tuberculosis are less susceptible to COVID-19 morbidity and mortality. Compare, for example, Spain and Portugal. On April 20, Spain had 20,500 deaths, whereas the Portugal had 700 deaths. BCG vaccinations are mandatory in Portugal but not in Spain.
  • BCG vaccine seems to have a stimulating effect on the immune system that goes well beyond tuberculosis. For that reason, perhaps, some countries are running trials of BCG against COVID-19. In South Asian countries, universal BCG vaccination is mandatory, while immune systems of people have a lifelong exposure to malaria.
  • These could provide possible explanations for the relatively limited spread of COVID-19 in South Asia so far.

Impact of lockdowns on Lives and livelihoods

  • Obviously, lockdowns have also mitigated the spread. In doing so, they have saved lives, but at the same time, they have also taken away livelihoods.
  • In South Asian countries, almost 90% of the workforce is made up of the self-employed, casual labour on daily wages, and informal workers without any social protection.
  • The lockdowns have meant that hundreds of millions of people who have lost their jobs, hence incomes, have been deprived of their livelihoods.
  • This impose a disproportionate burden on the poor and those who survive just above the poverty line. For them, the trade-off between getting sick and going hungry is no choice.


On April 20, the total number of infections in US is 21.7% of the world total while it is 0.33% for India. As of now, South Asia, with a share of 23.4% in world population, accounted for 1.25% of infections and 0.5% of COVID-19 deaths in the world.

This shows effective steps taken by south Asian countries to slow down the spread of COVID-19.

However, it is plausible to argue that, South Asian countries are in the early stages where community transmission has not gathered momentum. An explosive growth in infection numbers could yet surface later.

Hence, it is time for South Asia to start investing in strengthening the public health system.  Any aspirations for an increase in GDP allocation should be prioritised for the public health system, towards preventing diseases and promoting health. 

Mains 2020 Editorial Notes

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