The whole prospect and outlook of humankind grew immeasurably larger, and the multiplication of ideas also proceeded at an incredible rate. This vast expansion was unhappily not accompanied by any noticeable advance in the stature of human beings, either in their mental faculties, or their moral character. Our brain got no better, but it buzzed more. The scale of events around us assumed gigantic proportions while we remained about the same size. By comparison therefore we actually became much smaller. We no longer had great individuals directing manageable affairs. The need was to discipline an array of gigantic and turbulent facts. To this task we have certainly so far proved uneq ual. Science bestowed immense new powers on human beings and at the same time created conditions which were largely beyond our comprehension and still more beyond our control. While people nursed the illusion of growing mastery and exulted in their new trappings, they became the sport and presently the victim of tides, and currents, of whirlpools and tornadoes amid which they were far more helpless than they had been for a long time.

       For more than two years, people everywhere have been in the grip of a pandemic—but not necessarily the same one. In the affluent world, a viral respiratory disease, Covid, suddenly became a leading cause of death. In much of the developing world, by contrast, the main engine of destruction wasn’t this new disease, but its second-order effects: measures people took in response to the coronavirus. Richer nations and poorer nations differ in their vulnerabilities. 

      Whenever I talk with members of my family in Ghana, Nigeria and Namibia, I’m reminded that a global event can also be a profoundly local one. Lives and livelihoods have been affected in these places very differently from the way they have in Europe or the US.

       That’s true in the economic and educational realms, but it’s true, too, in the realm of public health. And across all these realms, the stakes are often life or death. The three countries I mentioned have a median age between 18 and 22 years, and the severity of Covid discriminates sharply by age. A big way that Covid can kill is by hampering the management of other diseases, such as HIV, malaria and TB. In Africa alone, 26 million people are living with HIV and, in a typical year, several hundreds of thousands die of it, while malaria, which is especially deadly to infants and toddlers, claims almost 400,000 lives.

      Those are big numbers, and yet they used to be much bigger—a major healthcare effort brought them down. Amid the pandemic, though, people stopped visiting clinics, in part because it became harder to get to them, and healthcare workers had to curtail their own movements. According to a Global Fund survey of 32 countries in Africa and Asia, prenatal care visits dropped by two-thirds between April and September 2020； consultations for children under five dropped by three-quarters.        Public-health experts predict that, as an indirect consequence of the Covid pandemic, twice as many people around the world could be at risk of dying from malaria. There could be 400,000 extra deaths from TB in the next few years, and half a million extra deaths from HIV. Across much of the world, in short, the response to the coronavirus has ushered in a shadow pandemic. The coronavirus’s real death toll, then, has to be calculated not just in deaths from Covid, but also in deaths that would otherwise have been prevented, from malaria, TB, HIV, diabetes and more. 

      This shadow pandemic isn’t simply a story about disease—it’s about poverty, hunger, truncated education and stunted lives. A suggestive comparison can be made with the climate crisis. In the affluent world, some people think of climate breakdown as a matter of how long the air conditioning stays on, but for many in the developing world, it’s already a matter of floods, droughts and famine.