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International Health

July 13, 2020

Global Health Experts Call for COVID-19 Research in Low- and Middle-Income Countries


In a Global Health Research and Policy Commentary, an international team of public health experts call for targeted COVID-19 research in low- and middle-income countries to help mitigate the effects of the pandemic. As of July 1, the confirmed cases of COVID-19 in LMICs have surpassed those in high-income countries.1 Yet, the authors warn, the impact of the virus on individuals and communities and prevention and response measures in these countries are still not sufficiently understood. Additional research could help inform targeted mitigation strategies and prevent LMICs from bearing the greatest burden of COVID-19, as the region does so often with infectious diseases.

The Commentary, published on July 1, was led by Madhu Gupta, MD, PhD, MBBS, a professor in the Department of Community Medicine and School of Public Health at the Postgraduate Institute of Medical Education and Research, and Brian Wahl, PhD, ‘17 MPH ‘13, an assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

The authors propose three broad areas of research in low- and middle-income countries:

  • Transmission patterns of SARS-CoV-2: Multiple factors such as dense living conditions, lack of access to soap and clean water, and unique social mixing patterns may make prevention efforts more difficult in LMICs than in higher-income settings. Understanding how these factors modify transmission patterns will be important to response efforts. In addition, more research is needed to understand the potential for fecal-oral transmission in LMICs.
  • The clinical characteristics of the disease: In high-income countries, COVID-19 causes less severe outcomes in younger individuals compared with older age groups. The authors speculate that COVID-19 could be more severe among younger individuals given the higher prevalence of risk factors for many respiratory infectious diseases and co-morbidities, including exposure to ambient air pollution and malnutrition.
  • The impact of pandemic prevention and response measures: The authors call for an assessment of the broader social and economic effects of the pandemic response. With low-income households already stressed, can people feasibly adhere to lockdown regulations? Early research also suggests that child and maternal mortality could substantially increase as a result of disruptions to routine health services, including immunization, antenatal care, and the provision of family planning services.

The authors call for a multidisciplinary approach to address these research topics. They stress that local investigators should take the lead and that limited human resources, funding, and medical supplies should not be diverted from pandemic response activities. The authors also encourage international cooperation and investments to support ongoing and new research efforts.

In addition to the Postgraduate Institute of Medical Education and Research and the Bloomberg School, authors are based at

  • KEMRI-Wellcome Trust Research Programme
  • Maimonides Medical Center
  • Makerere University School of Public Health
  • Muhimbili University of Health and Allied Sciences
  • Papua New Guinea Institute of Medical Research

The need for COVID-19 research in low- and middle-income countries was written by Madhu Gupta, Brian Wahl, Binita Adhikari, Naor Bar-Zeev, Sudip Bhandari, Alexandra Coria, Daniel J. Erchick, Nidhi Gupta, Shreya Hariyani, E. Wangeci Kagucia, Japhet Killewo, Rupali Jayant Limaye, Eric D. McCollum, Raghukul Pandey, William S. Pomat, Krishna D. Rao, Mathuram Santosham, Molly Sauer, Rhoda K. Wanyenze, and David H. Peters.