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The COVID-19 crisis has amplified existing inequalities all around the world. Many factors contribute to the amplification of vulnerabilities during an epidemic crisis: pre-existing health system conditions, deep-rooted and structural disparities, conflict, migration and displacement, uncontrolled population growth, among others. Despite considerable medical progress in the last decades, infectious disease outbreaks still represent a significant threat to human society and affect all spheres of life (humanitarian, social, economic, political, etc.). They also have wide-ranging effects on people and communities, especially on those most vulnerable. The current pandemic has shown that the world remains unprepared to detect and respond to outbreaks, particularly large-scale epidemic threats.  Therefore, medical advancement does not guarantee access to treatment for all, or the capacity and capability of states and societies to protect vulnerable populations.

The capacity of a country to control a pandemic episode is restricted by the ability to provide adequate protection to the most vulnerable. Therefore, this pandemic, as well as the recent Ebola outbreak, exposed the existing gaps and flaws in preparedness and effective response at the national and regional levels. The human and economic cost of the current COVID-19 crisis is a strong warning of the fragility of our current world and the prevalent inequities and vulnerabilities in all societies. The COVID-19 problem has shown that all health systems and economies are, to varying degrees, vulnerable, and that pandemic episodes bring to light (and deepen) existing inequalities and vulnerabilities, even in the most stable/developed contexts.

However, while all countries are at risk of infectious disease outbreaks, low- and middle-income countries (LMIC) may face even more considerable challenges. LMICs usually have vulnerable and weak public health systems which makes it more difficult to respond and manage the threat of a large-scale episode. Additionally, the social and economic conditions of many LMICs––such as lack of proper access to water and sanitation for big batches of population, poor urban planning, overpopulation, and prevalent and deep-rooted inequalities––may all aggravate the sanitary crisis. 

The vulnerability to large scale outbreaks that LMICs face is amplified in complicated humanitarian settings. In these contexts, prevention of transmission is difficult. Refugees and displaced people usually live in crowded spaces with limited possibilities of keeping safe hygiene practices. Countries with violence and conflict or in protracted natural emergencies with high scores in the vulnerability index are usually unable to respond to yet another crisis. Economic repercussions and the reduced possibilities of humanitarian agencies to respond, may further aggravate the situation.

Beyond the vulnerabilities of LMICs and humanitarian settings facing a pandemic or large-scale epidemic episode, the current COVID-19 crisis has revealed the existence of prevalent inequities and vulnerabilities in peaceful contexts. Developed countries with more robust health care systems and resources have failed to protect their most vulnerable populations. In those contexts, some ethnic communities, undocumented migrants, exposed healthcare personnel, essential workers, the elderly, and those who have comorbidities have been highly affected by COVID-19. For example, the situation of BAME doctors in the UK, African Americans and non-documented migrants in the US, or the elderly population in Italy, reveal the extent of this issue. 

Therefore, the psychosocial consequences of distancing and isolation have been considerable and have further revealed the vulnerable populations living in the Last Mile. While the COVID-19 pandemic is a worldwide health crisis that is stressing and overwhelming health systems, control measures to contain the outbreak have also aggravated existing political, economic, and social problems, and exacerbated vulnerabilities in both humanitarian and fragile settings, both in peaceful and developed contexts. 

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