National governments have varied hugely in their interpretation of WHO guidance on behaviour to prevent spread of COVID-19, from tight social restrictions at a fairly early stage of the epidemic in Wuhan, China, to a more relaxed interpretation in Italy and the UK. Sub-Saharan Africa settings (including Malawi) are in the process of developing their own interpretation of WHO guidance, often drawing on experiences of the Ebola epidemic to define appropriate behaviours.

The extent to which governments have accorded populations freedom to choose how to respond to the risk of infection on one hand or enforced stringent control measures on the other has also varied dramatically. In an international pandemic, the decisions and actions of individuals, communities, regions and governments are inextricably linked and all have a bearing on the speed and spread of infection globally.

Each country’s ability to contain the epidemic will not only depend on its public health response, but crucially will also reflect the extent of existing health inequalities, the strength of the health system and the cross-sectoral measures governments implement to shield the population from the social and economic fall-out from the pandemic. The capacity of populations to protect their health and adhere to social distancing, hygiene and self-isolation measures will necessarily reflect current health divides and the adequacy of social and welfare systems in place to mitigate them. The population groups at highest risk of severe disease from
Covid-19 infection are the elderly and those with chronic health conditions, a group which disproportionately comprises people living in vulnerable circumstances.

This study seeks to explore the capacity of the most vulnerable population groups in the UK and Malawi to respond to the risk of Covid-19 according to their socioeconomic position, to critique national policy responses to protect the health of those most at risk and to mitigate the adverse socioeconomic consequences of containment measures on population health and wellbeing across contrasting national contexts (UK and LMICs), with a particular focus on the added complicating effect of health and socio-economic health inequalities.