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The growth of the GDP is primarily driven by government spending on mega infrastructure projects (spearheaded by the military), leading to a boom in the construction sector. Government spending is financed by a bloated public debt, the burden of which is disproportionality shouldered by the lower segments of society.

the regime did not invest in the development of the manufacturing sector, and it did not lay down the foundation for sustainable, long-term economic growth

The decline in the level of consumption was not counteracted by an increase in the level of exports in goods and services. This is reflected in the value of Egyptian exports, which reached 47.45 billion USD in 2018, a decrease of 1.66 billion USD compared to 2013. Other indicators also reflect a worsening international competitive position. For example, the trade deficit ballooned from -6.34% of the GDP in 2013 to -10.45% of the GDP in 2018

the military directly employs 19.2% of the labour force. This makes the military the second largest employer in the country, after the public sector that employs 5.6 million.

projects include much-publicised mega infrastructure projects, with dubious economic benefit, the most notable of which is the new administrative capital. The construction sector, which is closely connected to the military led projects, played an important role in generating economic growth. In 2018, it is estimated to have grown by 8.9%, making it the number one contributor to the GDP growth

growth of the GDP is not driven by a dynamic private sector, but mainly by a massive military led construction spree, and mega-infrastructure projects that have little positive impact on increasing the competitiveness of the Egyptian economy

the unemployment rate, which reached 8.1% by the first quarter of 2019, the lowest in 10 years. This drop in the level of unemployment, however, requires some additional qualification. The rate of utilization, which measures the number of workers employed for at least one hour per week as a percentage of the population, has dropped from 44.5% to 39%. This is also accompanied by a reduction in the level of workforce participation from 46.4% to 41.6%, indicating a reduction in the level of those seeking work, rather than an increase in the number of available jobs. Loss of hope should be credited with the drop in the level of unemployment, not improved economic conditions.

profits generated from business owned by the armed forces are exempt from taxation, under law 96 (2015). This means that the government is shifting the burden on the shoulders of the poor, as they finance the military construction spree, which in-turn is used to enrich the military elites and other regime insiders

as debt continues to pile up, the pressure on the poor will continue to rise, as the government continues to cut social spending. This will reduce the level of effective local demand, leading to greater pressure on the private sector. In addition, if the construction spree continues, the possibility of overcapacity and over-accumulation of capital in the construction sector becomes more prominent. In essence, a bubble that is bound to burst.

He doesn’t understand how the economy works, how to get it going, how to generate jobs and growth, or how to increase revenue in a sustainable way. But the military is following orders. If he tells them to go build a new city in the sand somewhere, that is what happens.

The military now manages approximately a quarter of total government spending in housing and public infrastructure

Until the 2013 takeover, the military’s economic activities functioned to keep the senior officer corps happy and loyal to the president, by allowing them perks. Sisi, however, has made a different calculation. He is looking to reinforce the political legitimacy of his regime domestically, and to show Western governments and foreign investors that Egypt means business. He wants to demonstrate credibility. He’s shown his contempt openly for the civilian agencies of his own state. He feels he can only trust the military to do the job on time, within budget.

The military started by working on land reclamation - turning deserts into arable land. In the late 1970s, the army led the way in reconstructing cities and infrastructure along the Suez Canal that had been damaged severely during the war with Israel.

The economic consequences are increasingly negative, because Egypt is borrowing heavily to fund these projects.

The military’s main advantage is political influence. It has officers placed throughout the state apparatus who help get contracts. These officers also dominate the government’s main audit agency, which is instructed to inspect civilians to prevent corruption.

the problem here is that the military’s powerful political position means it doesn’t really have to account for genuine cost-effectiveness; the real problems are being kicked down the road.

Egyptian military accounts are not shared with anyone either inside or outside Egypt. This includes the official budget, in addition to the financial books of the various military agencies involved in economic and commercial activities.

the military pays no taxes on any of its activities, and no customs duties on the goods it imports for these purposes

All officers who perform duties on behalf of military agencies undertaking economic activities get paid extra allowances and benefits for each task they undertake, and often get an extra salary if they run a military factory or a military farm. And then there’s a share of profits - or of incomes before profits are calculated, because there’s not always a profit; a certain share of these are distributed to senior officers as well. 

Iraq has struggled to recover from the battle against Islamic State of Iraq and the Levant (ISIL) group between 2014 and 2017. Its infrastructure has been laid to waste by decades of sectarian civil war, foreign occupation, two US invasions, UN sanctions and war against its neighbours.

every state and society faces serious challenges. The difference lies in whether the underlying structures are healthy enough to effectively respond to those challenges. Viewed in this light, it’s less the arrival of the massive earthquake than whether the damaged infrastructure is rebuilt; not the crushing battlefield defeat, but whether competent new recruits and materiel can be found to replace what’s lost; not the feckless, no-clothes-having emperor, but whether the political system can either effectively work around him or remove him from power altogether. Successful states and societies are resilient when faced with even serious challenges. Falling empires are not.

it’s far more likely that the real meat of the issue will be found in a tax code full of sweetheart deals for the ultra-wealthy, the slashed budgets of county public health offices, the lead-contaminated water supplies. And that’s to say nothing of the decades of pointless, self-perpetuating, and almost undiscussed imperial wars that produce no victories but plenty of expenditures in blood and treasure, and a great deal of justified ill will.

Historians will look back at some enormous disaster, either ongoing now or in the decades or centuries to come, and say that it was just the icing on the cake. The foundation had already been laid long before then, in the text of legislation nobody bothered reading, in local elections nobody was following, in speeches nobody thought were important enough to comment on, in a thousand tiny disasters that amounted to a thousand little cuts on the body politic.

The pull of the past is strong. The mental frameworks through which we understand the world are durable, far more so than its actual fabric. The new falls into the old, square pegs into round holes no matter how poor the fit, simply because the round holes are what we have available.

Bureaucracy, in short, is all the fundamental building blocks of civilisation some people have the luxury of taking for granted.

These days, a westerner can hardly imagine how complicated the world would be without bureaucracy. But try to picture it: living without an address, without a social security number. Could you open a bank account? No. Start a business? No way. Register to vote? Never.And yet, about four billion people around the world have no address.

imagine having no proper tax authority. Without one, a government loses out on billions of dollars of potential revenue. There’s no money for social services or infrastructure. People living in poverty stay living in poverty.

people living in poverty own much more than they’re able to prove on paper. In Cairo, for example, they have $241.4bn worth of unregistered property, according to De Soto. In his book The Mystery of Capital (2000), he puts this figure into perspective: it’s six times all the money held in Egyptian savings accounts, 30 times the market value of every publicly listed company in Cairo, and 116 times the value of all Egypt’s privatised former state companies.

Without papers proving ownership, you can’t record the sale of your property or use it as collateral to secure a loan.The evidence is ample: bureaucracy – and the security that comes with it – is what people living in poverty need to climb out of poverty.

one agency after the other has started donating paperwork, Excel sheets and bookkeeping courses. They call it "capacity building".

Tax Inspectors Without Borders

British tax veteran Lee Corrick went to Kenya in 2011 to train local inspectors. For years, the Kenyan tax office had had problems with a big multinational company – something to do with tea auction licence rights and letters of credit. It sounds overly complicated, and the Kenyans thought so too. But after two workshops with Corrick and a stern talk with the multinational, the Kenyan tax office managed to collect $23m. In fact, revenues from Kenyan tax inspections doubled after Corrick came to town. And in Colombia, the take increased tenfold after training.

In one area, farmers’ land was officially added to a land registry; in another, it wasn’t. The researchers then looked at how the farmers used their land.Here’s what they found: farmers who owned their land on paper invested more. For example, they more often planted trees, such as oil palms, that would continue to provide income all their lives. And since they no longer feared their land would be snatched out from under them, they spent less time guarding it. That left them more time to do other things – like earn money.

If development economists and people living in poverty like Lebrun are calling for bureaucracy outright, why doesn’t everyone – aid organisations, governments, companies – get behind it 100%?The answer is simple. Bureaucracy is boring.

A TV ad showing a sweetly smiling Haitian girl who’s just got her first school uniform works better than one with a blah bureaucrat in a fluorescent-lit office drawing lines on paper with a ruler

capacity building remains the neglected stepchild

the truth is, real progress is a gradual, thoroughly bureaucratic, deadly dull process. Saving the world isn’t sexy.

The social wealth of a society is better measured by the quality of its common lived environment than by a consolidated statistical approximation like GDP, or even an attempt at weighted comparisons like so-called purchasing power parity. There is a reason why our great American cities, for all of our supposed wealth, often feel and look so shabby. The money goes elsewhere.

New York City and state, mired in graft and corruption, cannot build a single mile of subway for less than $2 billion

The United States spends perhaps a trillion dollars every year on its military and wars

Poverty—both individual and social—is a policy, not an accident, and not some kind of natural law. These are deliberate choices about the allocation of resources.

if the state- and city-level Democratic leaders of New York and northern Virginia are the national mold, then our nominally left-wing party is utterly, hopelessly beholden to the upward transfer of social wealth to an extremely narrow cadre of already extremely rich men and women

Media tycoon Karoui, a populist figure who until Wednesday sat in jail on suspicion of money laundering and tax evasion, took 15.6 percent of the vote. He denies all the charges and says they are politically motivated

In Ettadhamen, Saied's humble persona and rejection of the political status quo propelled him to the top, with 21.7 percent of the first-round vote. Karoui, who founded a charity to alleviate poverty and whose Nessma TV channel has promoted his philanthropic activities, trailed in second place on 19.4 percent. Despite his personal wealth, his supporters see him as a liberal champion of Tunisia's poor

In a country that ranks as the 73rd most corrupt out of 180 states, according to the Economic Research Forum, mistrust of the political elite has become widespread.

40 percent of Tunisia's unemployed have university degrees

it is still possible that Karoui will contest the results if he loses on Sunday - ushering in another period of political uncertainty. "Not only will the parliament be fractured and the government unstable, but the entire electoral mandate could be questioned as well,"

While Parliament drafts and votes on legislation, the president's mandate is limited to foreign affairs, defence and national security. But the language of the 2014 constitution remains relatively vague when it comes to setting out the jurisdiction of the president versus the head of government, the prime minister

"Given that there is no constitutional court to adjudicate between them, ultimately the distribution in power will be based on the personality of who occupies each position and how far they are willing to go to challenge one another,"

growing nostalgia for a strong, presidential system - a desire that is only likely to grow as the fractured parliament struggles to form a government - it is possible that the presidency will emerge as the stronger of the two executives

Most infamously, this led to a student-led seizure of the American embassy in Tehran 40 years ago this month, an action that toppled Iran’s liberal-leaning provisional government and permanently escalated tensions between Washington and Tehran.

Over the course of the past 40 years, Iran has routinely witnessed all varieties of rallies and riots; sit-ins by families of political prisoners; labor strikes by teachers, truckers, and factory workers; student demonstrations over everything from free speech to dormitory conditions and cafeteria food; soccer riots; and marches and sit-ins sparked by localized grievances. These manifestations have never been limited by geography or class.

The durability of the Islamic Republic is perhaps the most important legacy of 1979 revolution. None of the extraordinary developments within or around Iran over the course of the past 40 years has managed to significantly alter it — not the considerable evolution of Iranian society, nor the country’s steady reengagement with the world, nor the incremental reforms advanced by various factions within the establishment. In many respects, the structure of power in the Islamic Republic seems even more firmly embedded today than it was at any point since its precarious creation.

if war, internal upheaval, regional turmoil, natural disasters, crippling economic sanctions, and near-constant infighting among the political establishment have failed to weaken theocratic authority, perhaps any hope for change is simply futile

Iran’s “lost generation” is now approaching the age of the revolution itself, and the absence of a promising political or economic horizon has become painfully acute — and not simply for elites, but for the larger population of Iran’s post-revolutionary youth. These Iranians have benefited from the revolution’s dramatic expansion of educational opportunities and broader social welfare infrastructure. That legacy and the regime’s populist promises have shaped their expectations for a better life and sense of political entitlement to a functioning, responsive government.

The Iran Human Rights Documentation Center recorded more than 1,200 labor actions related to non-payment of wages between January 2017 and November 2018. The apex came in the final days of 2017 and early 2018, when what apparently began as a provincial political stunt quickly flared into a spasm of furious demonstrations. Within 48 hours, protests were convulsing in at least 80 cities, and the refrains of the demonstrators had catapulted from economic grievances to explicit denunciations of the system and the entirety of its leadership

It is clear from Tehran’s reaction to the latest eruption of protests that the leadership is unnerved, and for good reasons: the rapid progression from mundane, localized demands to radical rejection of the system as a whole; the transmission and coordination of protests via social media rather than mediated through the more manageable traditional press; the engagement of the government’s core constituency, the rising middle class; and the near-instantaneous dispersion from local to national.

In each of Iran’s most significant turning points over the past 150 years — the Tobacco Revolt, the Constitutional Revolution, the oil nationalization crisis, the 1979 revolution — financial pressures intensified and expedited the political challenge to the status quo.

Tehran today is facing an epic, interconnected set of crises: the crisis of unmet expectations, which feeds a crisis of legitimacy for a system whose waning ideological legitimacy has been supplanted by reliance on a more prosaic emphasis on state performance and living standards. Iran’s predicament is exacerbated by the uncertainties surrounding leadership succession, both with respect to the position of the supreme leader, who marked his 80th birthday earlier this year, and the legions of senior officials from the same generation who helped shape the post-revolutionary state from its inception.

Eventually, as happened 40 years ago in Iran, even the most well-fortified regime will shatter.

some of the continent’s more democratic states have failed to end corruption or deliver high levels of economic growth. On the other hand, Ethiopia and Rwanda achieved impressive successes, attracting international praise for reducing poverty and unemployment while consistently securing high economic growth

Ethiopia received almost $5 billion in foreign aid in 2018, while Rwanda received just over $1 billion. The figure for Rwanda is particularly striking when one considers that democratic Malawi, which saw a peaceful transfer of power to the opposition in June 2020, receives considerably less aid per person: $70 for each Malawian in 2018, compared with almost $91 for every Rwandan

recent trends in academic and policy research have played an important role in the rise of authoritarian development. These trends provided donors with an intellectual foundation for investing in countries that, on the basis of their human rights records, the EU and the UK might have been expected to avoid.

researchers suggested that when patrimonial systems are tightly controlled, waste can be minimized and resources channeled toward productive investments to support developmental outcomes

The combination of the rise of China, democratic malaise in the West, and the economic struggles of many African democracies has led citizens and political elites to increasingly question the value of democracy for development

there is some evidence that the empirical data used to identify Ethiopia and Rwanda as success stories may not be as impressive as it was first thought

official figures are part of a broader propaganda campaign designed to sell the regime both at home and abroad

The Tiger economies of East Asia, such as South Korea and Taiwan, entrenched the economic progress they achieved in the 1970s and 1980s by undergoing relatively smooth transitions to more open and inclusive—and hence legitimate and stable—political systems in the 1990s. The prospects for such transitions have always seemed less likely in Ethiopia and Rwanda, where opposition parties are not allowed to operate effectively and limited social and political cohesion remains a cause for concern.

While the jury is still out on Rwanda, the political foundations of economic development in Ethiopia appear to be crumbling. When the Ethiopian People’s Revolutionary Democratic Front (EPRDF) came to power in 1991, it initially appeared to have broken out of Ethiopia’s damaging cycle of repression and rebellion. Rather than seeking to enforce one ethnic identity over the others, the EPRDF committed to giving the country’s different communities the freedom and self-respect they had always desired. The government enshrined a right to self-determination in the Ethiopian constitution. However, the reality was very different

the ruling party kept itself in power by rigging elections and repressing opponents. As a result, many ethnoregional groups felt that in addition to being politically marginalized, they were denied the opportunity to press their concerns through democratic channels.

although he quickly won the 2019 Nobel Peace Prize for moving to end a long-running dispute with Eritrea and promising a raft of democratic reforms, Abiy was unable to return Ethiopia to political stability. Most notably, the growing political marginalization of the TPLF left the former dominant clique increasingly frustrated. Tigrayan leaders ultimately quit the government, while Abiy disbanded the EPRDF and replaced it with his own political vehicle, the Prosperity Party. From that moment on, civil conflict between the federal government and the TPLF, whose role was now limited to control over the Tigrayan regional government, became increasingly likely.

Since civil conflict began in November 2020, Ethiopia has had a new set of developmental challenges. Hundreds of thousands of citizens have been displaced, major infrastructure has been destroyed, and Abiy’s reputation as a reformer has been undermined. Moreover, there is a serious risk that even though federal government troops have regained overall control of Tigray, the TPLF will be able to wage guerrilla attacks that will continue to weaken political stability and investor confidence.

Abiy, like his predecessors, will use coercion to maintain political control, building up more problems for the future. Although negotiated and smooth political transitions are not impossible, they are less likely in heavily divided societies and have been rare in sub-Saharan Africa.

Although Ethiopia and Rwanda are often mentioned in the same sentence, Ethiopia is the more important example for the argument that authoritarian government models would serve Africa better than democratic ones. With a small population, a distinctive history, and an intensely authoritarian government, Rwanda is not a promising case from which to generalize. By contrast, Ethiopia, with a large and extremely ethnically diverse population, provides a more compelling example.

The empirical evidence in favor of authoritarian development models in Africa has always been remarkably thin. The vast majority of African states were authoritarian in the 1970s and 1980s, and almost all had poor economic growth. Fast-forward to today, and there are very few authoritarian regimes with the potential to join Ethiopia and Rwanda as notable success stories. Instead, most studies have found that democratic governments perform better when it comes to providing public services or economic growth.

On its own, Rwanda’s small and aid-dependent economy cannot sustain the narrative that authoritarian regimes perform better on development—and if it does not, there is no justification at all for supporting repressive regimes.

bloated, inefficient health-care system

Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable

decades-long process of shredding the nation’s social safety net

same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories

the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,”

The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us

Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

This year, the world’s coronavirus experts—and there still aren’t many—had to postpone their triennial conference in the Netherlands because SARS‑CoV‑2 made flying too risky.

In 2003, China covered up the early spread of SARS, allowing the new disease to gain a foothold, and in 2020, history repeated itself. The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans, and only confirmed as much on January 20, after millions had traveled around the country for the lunar new year. Doctors who tried to raise the alarm were censured and threatened. One, Li Wenliang, later died of COVID‑19. The World Health Organization initially parroted China’s line and did not declare a public-health emergency of international concern until January 30. By then, an estimated 10,000 people in 20 countries had been infected, and the virus was spreading fast.

Even after warnings reached the U.S., they fell on the wrong ears. Since before his election, Trump has cavalierly dismissed expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was twice ignored.

“By early February, we should have triggered a series of actions, precisely zero of which were taken.”

Travel bans make intuitive sense, because travel obviously enables the spread of a virus. But in practice, travel bans are woefully inefficient at restricting either travel or viruses. They prompt people to seek indirect routes via third-party countries, or to deliberately hide their symptoms. They are often porous: Trump’s included numerous exceptions, and allowed tens of thousands of people to enter from China. Ironically, they create travel: When Trump later announced a ban on flights from continental Europe, a surge of travelers packed America’s airports in a rush to beat the incoming restrictions. Travel bans may sometimes work for remote island nations, but in general they can only delay the spread of an epidemic—not stop it.

countries “rely on bans to the exclusion of the things they actually need to do—testing, tracing, building up the health system,”

genetic evidence shows that the specific viruses that triggered the first big outbreaks, in Washington State, didn’t land until mid-February. The country could have used that time to prepare. Instead, Trump, who had spent his entire presidency learning that he could say whatever he wanted without consequence, assured Americans that “the coronavirus is very much under control,” and “like a miracle, it will disappear.” With impunity, Trump lied. With impunity, the virus spread.

it found a nation through which it could spread easily, without being detected

sluggish response by a government denuded of expertise

In response to the global energy crisis of the 1970s, architects made structures more energy-efficient by sealing them off from outdoor air, reducing ventilation rates. Pollutants and pathogens built up indoors, “ushering in the era of ‘sick buildings,’ ” says Joseph Allen, who studies environmental health at Harvard’s T. H. Chan School of Public Health. Energy efficiency is a pillar of modern climate policy, but there are ways to achieve it without sacrificing well-being. “We lost our way over the years and stopped designing buildings for people,”

As of early July, one in every 1,450 Black Americans had died from COVID‑19—a rate more than twice that of white Americans. That figure is both tragic and wholly expected given the mountain of medical disadvantages that Black people face

The indoor spaces in which Americans spend 87 percent of their time became staging grounds for super-spreading events. One study showed that the odds of catching the virus from an infected person are roughly 19 times higher indoors than in open air. Shielded from the elements and among crowds clustered in prolonged proximity, the coronavirus ran rampant in the conference rooms of a Boston hotel, the cabins of the Diamond Princess cruise ship, and a church hall in Washington State where a choir practiced for just a few hours.

Between harsher punishments doled out in the War on Drugs and a tough-on-crime mindset that prizes retribution over rehabilitation, America’s incarcerated population has swelled sevenfold since the 1970s, to about 2.3 million. The U.S. imprisons five to 18 times more people per capita than other Western democracies. Many American prisons are packed beyond capacity, making social distancing impossible. Soap is often scarce. Inevitably, the coronavirus ran amok. By June, two American prisons each accounted for more cases than all of New Zealand. One, Marion Correctional Institution, in Ohio, had more than 2,000 cases among inmates despite having a capacity of 1,500.

America’s nursing homes and long-term-care facilities house less than 1 percent of its people, but as of mid-June, they accounted for 40 percent of its coronavirus deaths. More than 50,000 residents and staff have died. At least 250,000 more have been infected. These grim figures are a reflection not just of the greater harms that COVID‑19 inflicts upon elderly physiology, but also of the care the elderly receive. Before the pandemic, three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control. The Trump administration’s policies have exacerbated the problem by reducing the influx of immigrants, who make up a quarter of long-term caregivers.

the Department of Health and Human Services paused nursing-home inspections in March, passing the buck to the states. Some nursing homes avoided the virus because their owners immediately stopped visitations, or paid caregivers to live on-site. But in others, staff stopped working, scared about infecting their charges or becoming infected themselves. In some cases, residents had to be evacuated because no one showed up to care for them.

its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

“As public health did its job, it became a target” of budget cuts,

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

In May, Maryland Governor Larry Hogan asserted that his state would soon have enough people to trace 10,000 contacts every day. Last year, as Ebola tore through the Democratic Republic of Congo—a country with a quarter of Maryland’s wealth and an active war zone—local health workers and the WHO traced twice as many people.

Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.

Sabeti’s lab developed a diagnostic test in mid-January and sent it to colleagues in Nigeria, Sierra Leone, and Senegal. “We had working diagnostics in those countries well before we did in any U.S. states,”

American hospitals operate on a just-in-time economy. They acquire the goods they need in the moment through labyrinthine supply chains that wrap around the world in tangled lines, from countries with cheap labor to richer nations like the U.S. The lines are invisible until they snap. About half of the world’s face masks, for example, are made in China, some of them in Hubei province. When that region became the pandemic epicenter, the mask supply shriveled just as global demand spiked. The Trump administration turned to a larder of medical supplies called the Strategic National Stockpile, only to find that the 100 million respirators and masks that had been dispersed during the 2009 flu pandemic were never replaced. Just 13 million respirators were left.

The supply of nasopharyngeal swabs that are used in every diagnostic test also ran low, because one of the largest manufacturers is based in Lombardy, Italy—initially the COVID‑19 capital of Europe. About 40 percent of critical-care drugs, including antibiotics and painkillers, became scarce because they depend on manufacturing lines that begin in China and India. Once a vaccine is ready, there might not be enough vials to put it in, because of the long-running global shortage of medical-grade glass—literally, a bottle-neck bottleneck.

As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.

A study showed that the U.S. could have averted 36,000 COVID‑19 deaths if leaders had enacted social-distancing measures just a week earlier. But better late than never: By collectively reducing the spread of the virus, America flattened the curve. Ventilators didn’t run out, as they had in parts of Italy. Hospitals had time to add extra beds.

the indiscriminate lockdown was necessary only because America’s leaders wasted months of prep time. Deploying this blunt policy instrument came at enormous cost. Unemployment rose to 14.7 percent, the highest level since record-keeping began, in 1948. More than 26 million people lost their jobs, a catastrophe in a country that—uniquely and absurdly—ties health care to employment

In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves disconnected from medical care and impoverished. They join the millions who have always lived that way.

Elderly people, already pushed to the fringes of society, were treated as acceptable losses. Women were more likely to lose jobs than men, and also shouldered extra burdens of child care and domestic work, while facing rising rates of domestic violence. In half of the states, people with dementia and intellectual disabilities faced policies that threatened to deny them access to lifesaving ventilators. Thousands of people endured months of COVID‑19 symptoms that resembled those of chronic postviral illnesses, only to be told that their devastating symptoms were in their head. Latinos were three times as likely to be infected as white people. Asian Americans faced racist abuse. Far from being a “great equalizer,” the pandemic fell unevenly upon the U.S., taking advantage of injustices that had been brewing throughout the nation’s history.

Of the 3.1 million Americans who still cannot afford health insurance in states where Medicaid has not been expanded, more than half are people of color, and 30 percent are Black.* This is no accident. In the decades after the Civil War, the white leaders of former slave states deliberately withheld health care from Black Americans, apportioning medicine more according to the logic of Jim Crow than Hippocrates. They built hospitals away from Black communities, segregated Black patients into separate wings, and blocked Black students from medical school. In the 20th century, they helped construct America’s system of private, employer-based insurance, which has kept many Black people from receiving adequate medical treatment. They fought every attempt to improve Black people’s access to health care, from the creation of Medicare and Medicaid in the ’60s to the passage of the Affordable Care Act in 2010.

A number of former slave states also have among the lowest investments in public health, the lowest quality of medical care, the highest proportions of Black citizens, and the greatest racial divides in health outcomes

“We’re designed for discrete disasters” like mass shootings, traffic pileups, and hurricanes, says Esther Choo, an emergency physician at Oregon Health and Science University. The COVID‑19 pandemic is not a discrete disaster. It is a 50-state catastrophe that will likely continue at least until a vaccine is ready.

Native Americans were similarly vulnerable. A third of the people in the Navajo Nation can’t easily wash their hands, because they’ve been embroiled in long-running negotiations over the rights to the water on their own lands. Those with water must contend with runoff from uranium mines. Most live in cramped multigenerational homes, far from the few hospitals that service a 17-million-acre reservation. As of mid-May, the Navajo Nation had higher rates of COVID‑19 infections than any U.S. state.

Americans often misperceive historical inequities as personal failures

the largely unregulated, social-media-based communications infrastructure of the 21st century almost ensures that misinformation will proliferate fast. “In every outbreak throughout the existence of social media, from Zika to Ebola, conspiratorial communities immediately spread their content about how it’s all caused by some government or pharmaceutical company or Bill Gates,”

Rumors coursed through online platforms that are designed to keep users engaged, even if that means feeding them content that is polarizing or untrue. In a national crisis, when people need to act in concert, this is calamitous. “The social internet as a system is broken,” DiResta told me, and its faults are readily abused.

Like pandemics, infodemics quickly become uncontrollable unless caught early.

In 2016, when DiResta spoke with a CDC team about the threat of misinformation, “their response was: ‘ That’s interesting, but that’s just stuff that happens on the internet.’ ”

The WHO, the CDC, and the U.S. surgeon general urged people not to wear masks, hoping to preserve the limited stocks for health-care workers. These messages were offered without nuance or acknowledgement of uncertainty, so when they were reversed—the virus is worse than the flu; wear masks—the changes seemed like befuddling flip-flops.

Drawn to novelty, journalists gave oxygen to fringe anti-lockdown protests while most Americans quietly stayed home. They wrote up every incremental scientific claim, even those that hadn’t been verified or peer-reviewed.

By tying career advancement to the publishing of papers, academia already creates incentives for scientists to do attention-grabbing but irreproducible work. The pandemic strengthened those incentives by prompting a rush of panicked research and promising ambitious scientists global attention.

In March, a small and severely flawed French study suggested that the antimalarial drug hydroxychloroquine could treat COVID‑19. Published in a minor journal, it likely would have been ignored a decade ago. But in 2020, it wended its way to Donald Trump via a chain of credulity that included Fox News, Elon Musk, and Dr. Oz. Trump spent months touting the drug as a miracle cure despite mounting evidence to the contrary, causing shortages for people who actually needed it to treat lupus and rheumatoid arthritis. The hydroxychloroquine story was muddied even further by a study published in a top medical journal, The Lancet, that claimed the drug was not effective and was potentially harmful. The paper relied on suspect data from a small analytics company called Surgisphere, and was retracted in June.**

Science famously self-corrects. But during the pandemic, the same urgent pace that has produced valuable knowledge at record speed has also sent sloppy claims around the world before anyone could even raise a skeptical eyebrow.

No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the U.S. had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his unqualified son-in-law; that an armchair polymath would claim to have a “natural ability” at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, “I don’t take any responsibility at all.”

Trump is a comorbidity of the COVID‑19 pandemic. He isn’t solely responsible for America’s fiasco, but he is central to it. A pandemic demands the coordinated efforts of dozens of agencies. “In the best circumstances, it’s hard to make the bureaucracy move quickly,” Ron Klain said. “It moves if the president stands on a table and says, ‘Move quickly.’ But it really doesn’t move if he’s sitting at his desk saying it’s not a big deal.”

everyday Americans did more than the White House. By voluntarily agreeing to months of social distancing, they bought the country time, at substantial cost to their financial and mental well-being. Their sacrifice came with an implicit social contract—that the government would use the valuable time to mobilize an extraordinary, energetic effort to suppress the virus, as did the likes of Germany and Singapore. But the government did not, to the bafflement of health experts. “There are instances in history where humanity has really moved mountains to defeat infectious diseases,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It’s appalling that we in the U.S. have not summoned that energy around COVID‑19.”

People suffered all the debilitating effects of a lockdown with few of the benefits. Most states felt compelled to reopen without accruing enough tests or contact tracers. In April and May, the nation was stuck on a terrible plateau, averaging 20,000 to 30,000 new cases every day. In June, the plateau again became an upward slope, soaring to record-breaking heights.

It is no coincidence that other powerful nations that elected populist leaders—Brazil, Russia, India, and the United Kingdom—also fumbled their response to COVID‑19. “When you have people elected based on undermining trust in the government, what happens when trust is what you need the most?”

the United States underperformed across the board, and its errors compounded. The dearth of tests allowed unconfirmed cases to create still more cases, which flooded the hospitals, which ran out of masks, which are necessary to limit the virus’s spread. Twitter amplified Trump’s misleading messages, which raised fear and anxiety among people, which led them to spend more time scouring for information on Twitter.

The virus was never beaten in the spring, but many people, including Trump, pretended that it was. Every state reopened to varying degrees, and many subsequently saw record numbers of cases. After Arizona’s cases started climbing sharply at the end of May, Cara Christ, the director of the state’s health-services department, said, “We are not going to be able to stop the spread. And so we can’t stop living as well.” The virus may beg to differ.

The long wait for a vaccine will likely culminate in a predictable way: Many Americans will refuse to get it, and among those who want it, the most vulnerable will be last in line.

It is almost unheard-of for a public-health measure to go from zero to majority acceptance in less than half a year. But pandemics are rare situations when “people are desperate for guidelines and rules,” says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. The closest analogy is pregnancy, she says, which is “a time when women’s lives are changing, and they can absorb a ton of information. A pandemic is similar: People are actually paying attention, and learning.”

As the economy nose-dived, the health-care system ailed, and the government fumbled, belief in American exceptionalism declined. “Times of big social disruption call into question things we thought were normal and standard,” Redbird told me. “If our institutions fail us here, in what ways are they failing elsewhere?” And whom are they failing the most?

It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

On January 24, the government opened a control room to deal with the situation, made plans to isolate people, including home quarantine, and looked at the existing provisions of equipment including N95 masks, and PPEs (Personal Protective Equipment). On January 30, India registered its first Coronavirus infection in Kerala; it was a student who’d returned home from China.As of May 4, 462 people have recovered from the infection in Kerala, and there have been just three deaths. Even the oldest patients have recovered—a couple, aged 88 and 93. “When their tests came back positive, they were moved to a medical college because they were very vulnerable,” she shares. “In fact, we had special nurses and the best ICU set aside for them. And so, we brought them back to life,”

Kerala has long been focused on public health, education and social upliftment. Over the last few years, and since Shailaja Teacher got the health portfolio, there’s been renewed attention to the state’s public healthcare institutions. “We had a three-point agenda: government hospitals should be patient-friendly, high-tech, and out-of-pocket expenditure must reduce. Primary healthcare units are very important, especially in rural areas, they now have testing labs and are able to catch early signs of different diseases. Medical college hospitals have new equipment, and good infrastructure. Our focus definitely strengthened the system,”

a daily video conference with different frontline staff of the healthcare community across 14 districts. “Each day’s video conference is dedicated to groups of people doing different kinds of work, from district medical officers, nurses, ASHA workers. It gives us the opportunity to talk to people and hear them out. Keeping in touch with those working at the grassroots level is extremely important, we try to maintain that at all costs. When the minister, or a health secretary directly wants to understand their ground reality, it makes a huge difference, especially to keep morale up.”

Morale is especially important because there’s little knowing how things will pan out. Shailaja Teacher is cautious: “It will take time to get back to normal life. It is a truth that people must accept now. This virus is not like others. Many people test positive then test negative within a few days, but others take upward of 30 days to test negative. It sometimes takes five or six tests before it comes back negative. So that means this virus remains in the body for a while, and there’s a possibility of a transfer. In Kerala, we have it under control but if we get over-confident then we may have a second wave.”

When I spoke to Shailaja Teacher, she had another 9 or 10 hours of meetings, files, discussions, and even a press conference ahead of her. Her husband, two grown-up sons and their families, check in on her just before midnight via phone calls. 

Despite testing far less than its neighbors, Somalia has the highest death toll in East Africa. On April 17 and 18, 72 people were tested, out of which 55 were confirmed positive, a staggering 76 percent infection rate. Since this revelation, the Somali government has stopped sharing the numbers of people tested with the public.

Anecdotal accounts of COVID-19 symptoms and a spike in burials abound. “There is extraordinary community transmission. Infections and deaths are out of control,” explained a Mogadishu doctor on the condition of anonymity. “And why visit a hospital if they can’t treat you?” Somalia’s health infrastructure is mere scaffolding: scarce public hospitals struggling with a lack of equipment, unaccredited doctors in private facilities offering unaffordable services, and medication that is as low-grade as it is scarce.

Somalia’s best-equipped medical institution, Erdogan Hospital in Mogadishu, was shut down in April after 3 of its doctors were infected. Martini Hospital—kitted with 76 beds—is the only medical facility in the whole country designated to treat the infected

Answers to this acute health crisis lie in part with the government’s 2020 budget, which allocated $9.4 million for health spending, a mere 2 percent of the national budget. A whopping $146.8 million was reserved for security institutions—a telling indication of a cash-strapped state facing widespread security threats.

The group heralded the disease as divine punishment for the treatment of Muslims globally. Weaponizing the disease, al-Shabab ushered in Ramadan with an attempted vehicle-borne explosive attack at a military base on the first full day of the holy month.

Like the virus, al-Shabab transcends national borders and presents risks not only to Somalia but to its pandemic-weakened neighbors, particularly Kenya, which has weathered violent attacks from the group for years. Born out of a power vacuum itself, al-Shabab will capitalize on lapses in states’ security apparatus as governments redirect resources from preempting terror attacks to enforcing curfews

risks reversing critical security gains

Kenya’s northeastern towns lying on its border with Somalia have been particularly vulnerable to devastating al-Shabab attacks. In response to the illegal smuggling of people and goods from both Somalia and Ethiopia, Kenyan security authorities have recently ramped up aerial surveillance along its borders, in part, to curtail cross-border infection. Ethiopia’s health minister announced last week that 13 of its new cases were imported via illegal migration from Djibouti and Somalia

More than 80 percent of global trade passes through the Gulf of Aden

the resurgence of piracy can be expected

For more than a year now, the central government has been embroiled in a rancorous fight with two of its federal states. This being an election year, the fledgling Somali state finds itself at a critical juncture. It remains to be seen whether federal elections will be postponed, following in the footsteps of neighboring Ethiopia.

The disappearance of remittances—a lifeline for millions on the continent and estimated at $1.4 to $2 billion annually in Somalia alone—makes the situation all the more desperate. These critical cash flows have dried up as a global recession sets in and incomes of workers in the diaspora shrink.

harrowing statistics from across Europe show that Somali communities have been disproportionately affected by COVID-19. In Sweden, Somalis are dying from the virus at “an astonishing high rate” according to the BMJ despite accounting for only 0.69 percent of the population. The World Bank is calling on governments to designate remittance companies as an essential service, a crucial step to easing restrictions on these financial flows.

The populations most at risk in Somalia are those living in the densely populated camps scattered across the country. More than 2.5 million internally displaced people live in these cramped conditions, already weakened by malnutrition and compromised immune systems, and with limited access to clean water, soap, or bathrooms.

According to the World Food Programme, the number of food-insecure people in East Africa is projected to reach up to 43 million in the next few months—more than double what it is now—sparking fears of conflict over scarce resources.

The specter of drought and famine, alongside the unforgiving plague of locusts that has ravaged crops in recent months

deadly flash floods

will force more people to move, compounding the internal displacement crisis and heightening intercommunal tensions  even as it spreads the disease further

Border closures across the region have throttled migration flows, making it ever harder for people to escape conflict or starvation. This will simply force migration into the shadows, opening up avenues for human trafficking and exploitation. Irregular movement of refugees has already been observed across the Horn of Africa’s highly porous borders.

During  Friday prayers at Mogadishu’s Marwazi mosque on April 10, armed forces tried to forcibly disperse a congregation of worshippers without notice. A massive demonstration broke out, and shoulder-to-shoulder prayers continue across the country today

Riots swept the streets of Mogadishu again on April 24 in response to the fatal shooting of two innocent civilians by police as they tried to enforce a curfew. Ramadan, replete with nightly rounds of public taraweeh prayers, is likely to catalyze disease spread in the absence of clear communication with communities and Islamic leaders.

The virus demands self-sufficiency. Countries are forced to make do with their own systems, however broken.

government’s restrictions on press freedom and access to information about the novel coronavirus to the detriment of its own people

As has often been the case in the disaster-prone country, it will be up to grassroots community groups, the private sector, and members of the diaspora to mobilize en masse to contain the crisis.

Two officials at the Ministry of Health have already been arrested on corruption allegations related to COVID-19 response donations, denting public confidence.

With domestic flights suspended, it is all the more critical to invest in hospital and testing capacity across the country. This cannot be achieved without genuine collaboration between the federal government and its constituent member states.

in Tanzania, a global pandemic is colliding with a turn toward authoritarianism, making both problems far worse

Magufuli’s denials of the seriousness of the COVID-19 pandemic and the lack of transparency in the collection and sharing of data on rates of infections and deaths have raised concern at the Africa Centres for Disease Control and Prevention. Neighboring Kenya closed its border with Tanzania in May due to coronavirus concerns

A strikingly similar situation has unfolded in Burundi, where the country’s president is thought to have died from COVID-19 after months of official denials about the disease’s seriousness. The government even encouraged citizens to attend religious services and other large gatherings in the country. In Madagascar, too, the country’s authoritarian president has been dogged by criticism, including from the WHO, about his government’s response, or lack thereof, which has featured the promotion and distribution—including to Tanzania—of an unproven “herbal cure.”

those countries in Africa that have demonstrated the most effective COVID-19 responses are also the most democratic and transparent

Senegal and Ghana, which have led the continent in the development of affordable and effective rapid testing for the new coronavirus. Senegal, specifically, has stood out for its relative success, ranking No. 2 globally in Foreign Policy’s COVID-19 Global Response Index.

Some observers have argued that the pandemic might serve to strengthen democratic resistance and expose the weakness of authoritarian rule. It seems more likely that the vulnerable countries will get sicker before they can start to recover.