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Emergency medicine


“ Twalingana”:  We have become equal in COVID 19


Dr Wilbroad Mutale, MD, MPhil, PhD,




University of Zambia,   Vanderbilt University &  Teledoctor Zambia



As a researcher from a Low-income country,  I have had to put up with a “natural selection” and found it now acceptable that indeed poor countries will remain different in disease burden related to poor resources and associated weak health systems1,2. The narrative is very clear in conferences where this distinction is emphasized and global health researchers from Europe and US, have always found comfort in that they remain safe and can therefore continue to help the poor countries to fight pandemics like HIV, tuberculosis, malaria to mention a few. The idea of “equity’ in health  and health systems doesn’t seem appealing, in fact World Bank and IMF often discourage borrowing that is invested in  health and social welfare, assuming that making roads will somehow translate into better health and well-being. As a global citizen, I have had opportunities to live and work in Europe and US, and still using  my country Zambia as my home base. What is striking is the inequality I see in all these places. For example, in UK and US, you have very  poor and very rich living in the same country, a mixture of high- and low-income countries living in on county!3 You see for example how obesity has plagued the poor who live on fast food,  while the rich can chose good food and healthy diet and don’t die for lack of access to health care, they have good  health insurance cover, over and above what governments can offer. The disease burden is also different and so the rich always feel entitled and consider that they are  above any health  threat that plague the poor and vulnerable in society. Even the help I see from  the rich, can honestly be  understood as  linked to the benefit in lowered  taxes and brandy name of those helping, hence you always see big media coverage for any small dollars donated to the poor, but rarely do you hear about how much precious minerals are smuggled  from poor countries, and further consigning these to more poverty and ill health.


Another big story and narrative is that health systems are poor in LMICs, so diseases will continue to plague these people due to poor health systems and corruption which is endemic4.  But there is very little interest and corresponding resources to actually strengthen the health systems in poor countries, as it costs a lot of money and it is true,  the rich have not seen direct benefit from such investments. So, despite rhetoric in SDGs, like SDGs,  there is no real investments to achieve these in reality. We know that this is achievable if countries valued “equity in health and health systems” but currently this is not the case5.


To my point, the biggest lesson I have learnt from COVID 19, is not that it is infectious or kills people, which it does, but that human beings are “equal’ in vulnerability and made more vulnerable by ‘Inequity’ in health care and health systems, regardless of where they live on the planet. 

When China, started fighting COVID 19, it seems like a Chinese problem but look where we are! Italy and Norway have one of the best health systems, but look at what COVID 19 has done, there! The US is supposed to be a strong Economy and UK must be leaving the EU with a strong Economy but alas, we are all stuck “Equal in fear and worry’’ vulnerable regardless of our Economic status and insurance cover level. While the poor can die from COVID 19 in LMICs, they were already dying of other causes anyway, and so this will not be a strange thing, but they will surely act as “hosts’  of COVID 19, once it gets fully blown  in these poor countries as they will not be able to shake it off! Leaving everyone vulnerable unless we remain locked down for life!


What is the message to the global community: In COVID 19, we have seen that we are all “Equal” (in  Bemba, my local Zambian language we say: “Twalingana”). The artificial barriers we imagine, that the poor  are vulnerable to disease,  are no longer defensible and  should no longer be mentioned in public!  COVID 19 has shown this more clearly and  we should never again allow riches or poverty to divide us. We are one! We should invest globally in good health and health care for all! Where ever a human being exists, there should  be accessible good health care and a functional health system. Universal health coverage should be a human right, and we should not allow anyone again to keep diseases! An attack on Africa by any disease, should be treated as an attack to all in the global community! Investment in health system in Africa or Asia, should be treated as urgent and beneficial to everyone on earth! Poverty anywhere on Earth should be seen as a threat to global health and should be eliminated with the same effort we are seeing with COVID 19! It seems, we needed COVID 19 to wake us all to this reality!



About the author:

Is the faculty at the University of Zambia, a global health scholar and health systems advocate.







1.     Mutale W, Bond V, Mwanamwenge MT, et al. Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study. BMC Health Serv Res 2013; 13: 291.

2.     Aantjes CJ, Quinlan TK, Bunders JF. Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions. BMC Health Serv Res 2014; 14: 295.

3.     WHO. CVD Risk Management Package for low-and medium-Resource Settings. Geneva: World Health Organization; 2002: WHO, 2002.

4.     Norris SA, Daar A, Balasubramanian D, et al. Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations. Global health action 2017; 10(1): 1334985.

5.     Prof Louis W Niessen P, Diwakar Mohan D, Jonathan K Akuoku P, et al. communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet 2018; 18.



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Wilbroad Mutale
Member Since: Feb 15, 2020