As nations around the world scramble to bring coronavirus outbreaks under control, Dr. Raj Panjabi is worried that the world’s poor populations will be excluded from accessing treatments and prevention measures, a scenario he calls “viral apartheid.”
“I don’t use that term lightly,” said Panjabi, speaking with TIME Senior Writer Alice Park during a TIME 100 Talks discussion on May 28. “The idea that a group of people—whether it’s the vaccines, the test or treatments—will get access to those vital life-saving tools, and that those will likely be the rich nations and the powerful within those nations, and the poor within those nations and the poorer nations in the world will get excluded from that, is in fact the story of every pandemic that has happened in humanity.”
Panjabi, CEO and founder of Last Mile Health, has spent a career batting just those sorts of issues. His organization trains community health workers in essential medical services, like providing vaccines and neonatal care, in order to bridge the “last mile” to remote communities in countries like Liberia, where Last Mile Health has been working for the past 10 years.
As Panjabi tells TIME, that sort of community-based health infrastructure can both save lives and help to address the economic portion of the coronavirus crisis. For instance, countries can hire unemployed workers to be contact tracers, a tactic that can mitigate the health crisis while also creating much needed jobs in the health sector. By tracking and isolating exposed individuals before they spread the virus farther, those contact tracers can also help keep economies open and more people employed.
“Outbreaks start and stop in the community,” he says. “If we can hire the people from the communities most affected to be part of the medical team, I think we have a better chance of closing the equity gap.” And when vaccines are eventually produced, those newly-trained health workers may be able to expand their skills in order to distribute and administer vaccines.
“One of the opportunities I think the United States has, as well as other countries, is to really break this false narrative that’s been created, that we need to save lives or save jobs,” he explains. “We can actually create jobs and save lives.”
Panjabi holds no illusions about the magnitude of the worldwide crisis, especially in developing countries. An April United Nations Economic Commission for Africa report predicted that the continent could see between 300,000 and 3.3 million coronavirus-related deaths this year. In places with limited health infrastructure, the pandemic could also create setbacks in battles against other health scourges, like measles, which caused more than 140,000 deaths worldwide in 2018. “We’re seeing that in many low and middle-income countries that there’s a dual threat, the virus itself, but there’s a threat from the fact that people will die from other epidemics because the virus is disrupting the healthcare systems,” Panjabi says.
Still, there have been notable successes, Panjabi says, such as South Africa’s deployment of 28,000 contact tracers. “They were able in the first month to screen seven million people. That’s one out of 10 South Africans.” Such measures can offer lessons for building community health infrastructure in the U.S., which on May 27 passed 100,000 coronavirus deaths. “Imagine if Boston screened one out of 10 Bostonians,” Panjabi says. “Community health workers are vital for helping us test, trace, refer those for treatment and those for isolation and supporting them. And we simply can’t do this without a community-based approach.”