Saturday 29 August 2020

Jany Haddad - surgeon, pastor, leader, mentor and family man

Jany Haddad (born Teheran, Iran, 13 March 1954, died Aleppo, Syria, 14 August 2020)

‘Doctor, we plead with you, please do not leave Aleppo, you are the salt of this land. You are the light of this city.’

So spoke Dr Jany Haddad’s Muslim patients during the dark days in Syria when hundreds of thousands were escaping the country to seek refuge in Europe and beyond.

Dr Jany stayed, while the bombs fell and the bullets flew, through ten years of the Syrian civil war operating on the wounded, caring for the sick and ministering to the broken.

Jany was a monumental figure and a leader among leaders, deeply loved by many. His achievements were breath-taking, and he will be very greatly missed.

As the founder and president of both the Armenian Christian Medical Association (ACMA) and ‘Living Hope for Family Ministries’ he touched the lives of thousands and he inspired many others to join him and share in the work to which God had called him.

Jany Haddad was born in Tehran, Iran, in 1954. He graduated from Damascus medical university in Syria then specialised in general surgery. He trained and worked in Kuwait, later gaining FRCS in Glasgow, Scotland. He later gained training in 13 surgical subspecialties including oncology, endocrine, microsurgery and laparoscopy.

He married Sonig Arabian in 1982 and God blessed them with three children: Fouad (engineer), Manana (dietician) and Pethia (plastic surgeon).

In 1985, he and Sonig started family ministry together in Kuwait, interrupted by the Iraqi invasion.
When the Armenian earthquake struck in 1988, killing 50,000 and injuring 130,000, he felt God calling him to help this nation and chartered two shipments of medical supplies.

In 1990, Jany moved to Syria, where he started the family ministry once again in 1992, in Aleppo, with annual family conferences.

In 1996, God guided him to found ‘Living Hope for Family Ministries’, registered initially in Lebanon. The ministry expanded quickly and Jany wrote, translated, and published many books on Christian family principles and discipleship.

In 2002, he had a vision of starting a Baptist church in Aleppo, and in 2003, when others joined him, the Baptist Evangelical Church of Aleppo was born. This was to become a seed which led to the planting of other new Syrian churches.

In 2003, during the Iraqi war, Jany began ministering among the Iraqi refugees, with medical care, food and supplies.

During this time, he visited Armenia twice a year from 2000, running charitable surgical clinics for the poor in rural villages and towns. This led to him founding the Armenian Christian Medical Association (ACMA) in 2006, which ran annual leadership conferences and weekly mobile medical and dental clinics.

When the pastor of the Evangelical Baptist Church in Aleppo migrated with his family in 2013, Jany took over as pastor, and expanded ‘Living Hope’ between 2013 and 2020 to embrace a huge range of charitable and relief work during the Syrian war which had started in 2011.

This included support for internally displaced Syrians, digging 41 wells for drinking water (Isaac Project), spiritual and practical care for war widows and orphans (Ladies of Living Hope), University student ministry and the St Luke and Healing Grace medical charity centres.

The ‘Building Restoration Department’ helped families restore and renovate their homes which had been damaged or destroyed during the war. An elderly people’s ministry cared for the medical, social and spiritual needs of those who had been left behind after their families left the country.

Other initiatives included a mini-enterprises ministry providing food, a post-war trauma care centre, a psychological support centre, and training in sewing and other skills.

Jany died from complications of COVID on 14 August. It may be hard to understand why God should preserve Jany through the war only to take him in this way at a time when he seemingly had so much more to give and was still, even at 66, effectively in his prime.

The mystery remains, but the Lord is sovereign. His ways are always perfect and he always in all things works for the good of those who love him.

Jany is now in the presence of the Saviour he loved and served and has finished the race. He joins that great cloud of witnesses cheering the rest of us on.

He leaves behind friends and colleagues from all over the world who he encouraged and inspired and who are thanking God for his faithfulness to Christ and his wonderful service to God’s church and the Syrian and Armenian people as a surgeon, pastor, leader, teacher and mentor.

The words posted by his daughter Pethia this week, on behalf of his children and their families, are a lovely tribute:

‘Our beloved father, you are now with your Saviour… You planted in us the love of God and the spirit of service since our childhood, have nurtured in us our abilities and talents and were the motivation to reach successes we didn't dream about. You were the perfect husband, the caring father, the honest shepherd and the healing doctor who healed thousands of souls and bodies with his smile, words and blessed touch…. We trust God's appointments and know with all certainty that your mission has not yet come to an end. We will continue it.’

Sunday 23 August 2020

Prophet, Priest and Prince - Haggai 2:1-23

I preached this sermon on Sunday 23 August 2020, the second in a series of two on the book of Haggai.

If you were with us last Sunday, you will be familiar with the historical backdrop to the book of Haggai.

Jerusalem – the capital of the Jewish Kingdom - was destroyed by the Babylonians in 587 BC and those Jews who had not been killed were taken into exile in the city of Babylon, in modern day Iraq.

It was about 50 years later in 538 BC that the conqueror of Babylon, Cyrus King of Persia, issued a decree allowing them to return to Jerusalem and rebuild the temple.

Led by the Royal Prince Zerubbabel, about 50,000 Jews journeyed home and within two years completed the foundation of the temple amid great rejoicing.

However, their success aroused the Samaritans and other neighbours who feared the political and religious implications of a rebuilt temple in a thriving Jewish state.

So, they opposed the project vigorously and managed to halt work until Darius the Great became King of Persia 16 years later in 522 BC.

Darius was keen to promote all the religions in his empire, to ensure peace between culturally diverse people, and it was in his second year, 520 BC that this book is set.

The Prophet Haggai, after whom the book is named, gives a series of four messages during a few months encouraging Zerubbabel and the High Priest Joshua to rebuild the temple.

Last week we looked at the first of these messages which was an exhortation to get on with the work of rebuilding the temple.

We also looked at how that might apply to us as God’s living temple today – encouraging us to use our gifts of speaking and service to build each other up as members of the body of Christ.

In this second chapter, Haggai gives three more messages over the space of just a few months – in our time from October to December 520 BC.

The NIV Bible translation helpfully breaks this chapter into three sections, and we will look at each of those in turn. Each one has a clear message to us.

1 Trust God’s promises – 2:1-9

We are told in chapter 2 verse 1 that the word of God came through Haggai to Zerubbabel and Joshua on the 21st day of the seventh month in the Jewish calendar – that is the 17th October 520BC.

He asks them to compare the temple they were building with Solomon’s temple beforehand.

Now, by comparison, Solomon's temple was extraordinarily beautiful, opulent and lavish. This new one was much smaller and less impressive.

In fact, in the eyes of some of the older members who remembered the previous temple before its destruction by the Babylonians, this one seemed a pale shadow.

However, Haggai reminds them that God is true to his promises to bless his people and exhorts them to be strong, to continue the work and not to be afraid.

Their work of temple restoration is something he planned long ago, and he will make sure that they succeed.

Although they must have felt daunted by the strength of the opposition and the power of the nations around them, not least the Persian Empire itself, God reminds them that he is going to shake all nations.

God is much bigger and more powerful than the Assyrians, the Babylonians, the Persians and of course the Greeks and the Romans still to come.

He is in control and his purposes will be fulfilled no matter what.

The phrase, “the desired of all nations will come, and I will fill this house with glory”, in verse 7 has provoked great debate among theologians and Bible commentators.

Does it refer to the silver and gold that we know, from Ezra 6:8, King Darius gave the Jews to furnish the temple with, or is it a reference to the coming of the Messiah in the future?

Well, I'm going to suggest that it could well be both. The immediate context in verse 8 is silver and gold. But there are also verses in the New Testament that appear to make reference to this phrase in referring to the Messiah.

Regardless, the crucial point is that God enables his people to fulfil the work he prepares for them. He makes sure they succeed.

Does that encourage you? One of my favourite verses in Scripture is Ephesians 2:10 where the Apostle Paul talks about the “good works, which God prepared in advance” for us to do.

Each day God has prepared fruitful labour for each of us to engage in.

How often do we look with disappointment at the small amount of fruit we see in our lives, or in our Christian community, rather than looking forward with confidence and expectation to what God can build from small beginnings when we are faithful in the present? God describes the same scene in Zechariah 4:10:

“Who despises the day of small things? Men will rejoice when they see the plumb-line in the hand of Zerubbabel”, he says.

They are rejoicing not at the finished building – but just at someone holding a plumb-line to measure it up. Because in the hands of God, a small beginning is the guarantee of the completed task.

The whole of Christian history is full of stories of people who were faithful in small things which led later, perhaps not even in their own lifetime, to great fruit that was beyond their wildest imaginings.

What small but significant task are you currently involved in in God’s service – in your family, workplace, community or in the church itself?

Be encouraged to press on. God is faithful to his promises and his purposes, worked out in small steps of obedience by his people, will be fulfilled.   

Trust God’s promises.

2 Prepare for God’s blessing – 2:10-19

Haggai’s second message, we read in 2:10, came on the 24th day of the 9th month the same year - that’s the 18th of December.

Haggai asks the priests two questions.

First, he says “if a person carries consecrated meat in the fold of his garment, and that fold touches some bread or stew, some wine, oil or other food, does it become consecrated?” The priests answer “no”.

He then asks them a second question: “if a person defiled by contact with a dead body touches one of these things does it become defiled?” The priests reply “yes”.

Haggai is referring to regulations in the Old Covenant law of Leviticus. The point is that clean things cannot make dirty things clean, but dirty things can make clean things dirty.

Imagine, for example throwing some clean clothes into a pile of muddy rugby gear. Would the dirty clothes become instantly clean? Of course not. Similarly, dirty rugby gear jammed into a drawer of clean linen will certainly make it dirty.

So, Haggai is saying that the Jewish people are unclean because of their sin and so end up defiling everything they touch, even the temple itself.

if we try to do God’s work of building up God’s people, our efforts will not be blessed if our own lives are not right.

Haggai urges them to “give careful thought” to what is happening.

He points out in verses 15 to 19 the poor harvest of grain and wine and the fact that their crops were destroyed by blight, mildew and hail; that there was little seed left in the barn or fruit on the trees.

This, he says is a direct consequence of their sin.

Note, in verse 17, that it is God himself who “struck all the work of (their) hands”. He did this to catch the people’s attention and draw them back to himself. However, he says “you did not turn to me”.

These words are reminiscent of the words of another Prophet.

Amos chapter 4 follows the same pattern.

God declares through Amos that he struck his people with famine, drought, and their gardens and vineyards with blight and mildew; sent plagues among them and allowed them to be slaughtered by their enemies. These things did not just happen. God made them happen.

Amos ends each declaration with the same words we see here, “yet you have not returned to me”.

So, we see God withdrawing privileges and causing his people pain to save them from the far greater peril of being completely abandoned by him and facing his judgement.

The writer of Hebrews reminds us that “God disciplines those whom he loves” (Hebrews 12:5), and that this discipline is “for our good that we might share in his holiness” (Hebrews 12:10). He goes on to say that we should “endure hardship as discipline” because “God is treating us as sons” (Hebrews 12:7).

Now we should not draw from this that all hardship we face is a consequence of our own personal sin. We live in a fallen groaning world and all of us bear its consequences. Jesus did too.

However, the biblical pattern is that often the fate of a community, society, country, or empire is a direct consequence of its corporate sin. God removes his blessing and brings pain to cause us to turn back to him.

Haggai does not identify specific sins in this passage, unlike many of the former prophets. He has of course pointed out the people’s sins of omission in chapter one. They were so consumed with their own affairs and their own private property that they neglected to serve the people of God.

But the call here is one of turning from sin generally and it should perhaps lead each of us to allow God to examine us to help us see what in our lives is not pleasing to him.

Let's leave that as an open question for each one of us. What is it that we personally are doing, or failing to do, that is stopping us serving God with all our heart, soul, mind and strength? It is not generally a difficult question to answer.

What is it that we are looking at, thinking about, longing for, engaging in that is robbing our hearts of blessing and instead cursing our steps?

The message of this section is very clear. If we want to be effective in serving the Lord then we need, again in the words of Hebrews, to “throw off everything that hinders and the sin that so easily entangles” in order to “run with perseverance the race marked out for us ” (Hebrews 12:1).

You cannot run when you are weighed down with lead weights. What sin is sapping your strength?  Identify it and cast it off.

If we wish to be used by God - because that is what real blessing is – then we need to get serious about sin in our lives. And then the words that conclude this section, “from this day on I will bless you” will be true of our lives, families and churches. God will use us more effectively.

Prepare for God’s blessing.

3 Know that God will fulfil his purposes – 2:20-23

Haggai’s third word, we are told, comes on the same day as the second, the 24th day of the ninth month or the 18th of December.

Haggai tells Zerubbabel that God is going “to shake the heavens and the earth”, “overturn royal thrones” and “shatter the power of foreign kingdoms”. He will “overthrow chariots and their drivers; horses and their riders will fall each by the sword of his brother”.

You can see references here to the defeat of the Egyptian Army in the Red Sea but also periods in Israel's history when their enemies turned on each other rather than Israel itself.

God was the architect of all these victories because he is completely sovereign. In the same way he will act in the future.

190 years later in 330 BC Alexander the Great would sweep across the whole of the Middle East with his armies and destroy the great Persian Empire. Then the Romans would crush the Greeks.

Throughout biblical history we see the rise and fall of great kingdoms which ruled over most of the known world: Egypt, Assyria, Babylon, Persia, Greece and Rome.

This progression is beautifully described ahead of time by the Old Testament prophets like Daniel, who reminds us repeatedly that “the Most High is sovereign over the kingdoms of the world and gives him to anyone he wishes” (Daniel 4:18, 25, 32).

God is sovereign over the rise and fall of nations and empires.

Ever since, many other great empires ruling vast tracts of the world’s surface have followed Rome and many great rulers have come and gone.

The Goths, the Mongols, the Ottomans, the Spanish and Portuguese, the French and British, the Communists, the Nazi and now we see the United States and China battling it out in trade wars for world domination.

God has always “shaken the nations”. He always will.

With the benefit of hindsight, we can look back from 2020 over the 2,500 years between the time this book was written and our own day. We see the life death and resurrection of Christ, the extraordinary growth of the church and the spread of the gospel almost now to every nation on earth.

Haggai wasn’t privy to this much detail about the future but, under the inspiration of the Holy Spirit, he finishes this short book in a most interesting way.

“On that day”, says the Lord, “I will take you my servant Zerubbabel, son of Shealtiel and make you like my signet ring for I have chosen you declares the Lord Almighty”.

The signet ring was used by a king to stamp documents with his authority.

When Zerubbabel’s grandfather King Jehoiachin was captured by the Babylonians his signet ring was removed, thereby stripping his authority. There were no kings in the royal line after Jehoiachin.
But Zerubbabel is to be God’s signet ring, carrying God’s stamp or authority.

The expression “Zerubbabel, son of Shealtiel” crops up twice in the New Testament, in the genealogies of Jesus in Matthew 1 and Luke 3.

Both genealogies trace Jesus’ family line from Abraham through King David, but the list of names which follows David is different in each. Matthew traces Jesus through David’s royal son Solomon, and Luke through David’s son Nathan.

It is thought that Matthew’s line is that of Joseph, Jesus earthly father, and Luke’s line that of Mary Jesus’ earthly mother.

But interestingly, Zerubbabel, and his father Shealtiel, are the only people to appear in both genealogies.

Is this a strong hint that the Messiah will be a descendant not just of Abraham, Isaac, Jacob, Judah and David but also of Zerubbabel?

That the life of this faithful prince is a pointer to the Faithful Prince who is still to come – the Prince of Peace, Jesus Christ. Well I’ll leave you to ponder on that.

There are three great characters in this small book, and it is I am sure no mistake that they are a prophet (Haggai), a priest (Joshua) and a Prince (Zerubbabel).  

Together they did a great work, but someone would come just over 500 years later who Moses called the Prophet (Deuteronomy 18:15), who the writer of Hebrews called our great High Priest, and who the angels called the King of Kings. Someone for whom Haggai, Joshua and Zerubbabel are but pointers.

Someone who would speak God’s word like never before, who would usher us into the very presence of God the Father, and who would rule over all of the universe for ever and ever.

Trust God’s promises. Prepare for God’s blessing. Know that God will fulfil his purposes. 

Let us celebrate these wonderful truths as we exalt Jesus Christ our Lord and Saviour, our glorious prophet, priest and king in our final hymn, Rock of Ages.

All for sin could not atone; Thou must save, and Thou alone.
When I soar to worlds unknown, See Thee on Thy judgement throne,
Rock of Ages, cleft for me, Let me hide myself in Thee.

Thursday 20 August 2020

A message for our time - Haggai 1:1-15

I preached the following message at our church’s evening service on Sunday, 16 August.

The British Museum reopens following its closure for COVID on 27 August - and you can book a timed ticket in advance.

If you are planning a trip then one of its most famous exhibits is a clay artefact called the Cyrus cylinder (above).

It was found by British archaeologists in the ruins of Babylon in 1879 and measures about 20 centimetres in length and 10 centimetres in diameter.

The writing on it is in Akkadian cuneiform and it records the entry of the Persian King Cyrus into the capital city of Babylon in 539 BC.

Cyrus was regarded as a peaceful and competent successor to the tyrant Babylonian King Nabonidus whom he replaced.

He dreamed up an ingenious way to gain the loyalty of an extremely diverse multicultural society by giving each national and cultural group the freedom to carry out their own religious practices without interference.

And so, one of his first actions, as recorded on the cylinder, was to equip peoples who had been enslaved during the Babylonian exile to go back to their homelands and re-establish their nations with his own protection and support.

And so it was that the Jewish exiles in 538 BC returned to Jerusalem to rebuild the city.
Among this group of exiles were two young men called Zerubbabel and Joshua.

Zerubbabel was a royal prince and a direct descendant of King David and the Kings of Judah.
Joshua was a high priest.

Both wanted to resurrect their country after a time of great difficulty.

We first learn about Zerubbabel and Joshua in the book of Ezra where they are mentioned in chapters 3 and 5.

They also feature in the book of Zechariah which immediately follows Haggai chronologically.

The original temple built by Solomon 400 years earlier had been demolished by the Babylonians in 587BC when the Jews were exiled.

They began the task with great enthusiasm and built an altar along with the foundation of the temple but then, because of the opposition they faced from the locals, and because the task was difficult, they stopped.

It was 16 years after this that the events which we are considering tonight took place.

Haggai was a Jewish prophet who was sent by God to encourage Joshua, Zerubbabel and others to start rebuilding the temple.

Chapter 1 of Haggai begins on the first day of the sixth month of the second year of King Darius, King of Persia, the grandson of Cyrus.

That's the 29th of August 520 BC. Seldom are biblical dates identified so specifically.

The chapter ends - just 23 days later - on the 24th day of the same month or the 21st of September 520 BC.

So, these events took place almost exactly 2,540 years ago in Jerusalem.

Now the people had rationalised their inactivity over the temple – look at verse 2: “the time is not yet come for the Lords house to be built”, they said.

And yet, they seemed to be able to find plenty of time – verse 4 – for building their own houses while, we're told, the Lord’s house – the temple - remained a ruin.

Not only this, but the restoration of their own houses had been done in a rather lavish fashion.

The expression used here - “panelled houses” - is usually connected with royal dwellings which had cedar panelling.

So, they hadn't spared any extravagance.

And so, Haggai urges them to “give careful thought to their ways” and directly links the difficulties that they are facing with the fact that they have been unfaithful to God.

They were concerned about their own homes, but not his.

They were consumed with their own affairs and neglecting his.

The way they had spent their time and money laid bare their true priorities.

Haggai tells them that their poor harvests and the fact that they don't have enough to eat and drink or adequate clothes to wear are the result of God removing his blessing as indeed he had promised he would do in the Jewish law - see Deuteronomy 28:38-39.

“You earn wages, only to put them in a purse with holes in it”.

In other words, their money wasn't stretching far enough.

Of course, when too much money is chasing not enough goods and services we know that that leads to inflation. The money has less and less buying power.

So the nation of Judah was experiencing economic recession and inflation.

God tells them explicitly - verse 11 - that the lack of rain on their fields is because of a drought which he has personally ordered to curse those three vital products - grain, new wine and oil – which were the backbone of the economy.

This affected not just the people but their cattle as well. Why was this?

“Because of my house, which remains a ruin, while each of you is busy with his own house” – verse 9.

You see, it wasn't so much what they did, but rather what they neglected to do. These were sins of omission.

Now throughout biblical history people have reacted in different ways to prophetic words.

Many of the prophets were ignored, persecuted or even killed because people didn't appreciate the messages they brought.

However, this is one of those rare occasions when the prophetic words are taken to heart.

We are told that Zerubbabel, Joshua and indeed the whole remnant of the people – verse 14 - “obeyed the voice of the Lord their God and the message of the Prophet Haggai”.

They recognised that God had sent him and they feared the Lord.

Haggai, after his word of exhortation, brings a strong word of encouragement to tell them that the Lord is with them - verse 13.

And we are told that the Lord “stirred up the spirit” of Zerubbabel and Joshua and so they began the work of rebuilding the temple.

So, what can we learn from this seldom read obscure passage in the Old Testament that is relevant to us in 21st century coronavirus Britain?

As it turns out, quite a lot.

First, it reminds us that God is absolutely sovereign over the course of history.

He rules over political, economic and environmental events.

In fact, he does everything according to his own timetable.

The rise and fall of nations, the seasons, droughts and floods, crop failures and indeed even the price of food, drink and clothing are under his direct control.

Yes, even coronavirus with all its dramatic effects on politics, employment, economics and health.

These men were simply pawns working out a divine plan.

The Prophet Jeremiah, as remembered by the Prophet Daniel, had prophesied that the exile would last 70 years.

The Babylonians had destroyed Jerusalem along with the original temple in 587BC.

And according to the divine timetable, the temple was eventually completed 70 years later in 516BC.

It was indeed the right time.

God is sovereign and his purposes can never be thwarted.

He is always in control. Isn’t that a comforting thought!

Second, this account reminds us of the importance of prophecy.

Had it not been for Haggai’s timely intervention the Jews may never have questioned their behaviour.

It had to be pointed out to them.

They were blind to it.

The Prophet points out the sin, explains its results, tells them what they need to do to change and then encourages them to do it.

Now, of course, there are differences between Old and New Testament prophets.

But we know, from references in the book of Acts and the letters of the New Testament, that prophetic ministry was an important part of the early church, and there's no indication that this kind of ministry is no longer relevant.

It is noteworthy, that in our present time of national crisis, there have been very few prophetic Christian voices calling the church or the nation to repentance.

Third, we need to think about how the lessons of this chapter might apply to us in 21st century Britain.

As Christians we do not have a temple, and our church buildings, which function largely as a place of meeting, teaching and worship, have a very different purpose than that of the temple.

So, key question, what is the equivalent of the temple today, and what does “building the temple” mean for us.

Thankfully the New Testament is very clear about this.

The Apostle Peter tells us that the equivalent of the temple today is the people of God.

1 Peter 2: 4 : “as you come to him, the living stone - rejected by men but chosen by God and precious to him - you also, like living stones, are being built into a spiritual house to be a holy priesthood, offering spiritual sacrifices acceptable to God through Jesus Christ.”

So, the temple is now God's people. Jesus Christ is the cornerstone and all of us are “living stones”.

What then does it mean then to build the temple?

Ephesians 4:11-16 tells us that God gave “some to be apostles, some to be prophets, some to be evangelists and some to be pastors and teachers…”


“To prepare Gods people for works of service so that the body of Christ may be built up until we all reach unity in the in the faith and in the knowledge of the Son of God and become mature attaining to the whole measure of the fullness of Christ.”

Just two verses later “speaking the truth and love, we will in all things grow up into him who is the head, that is, Christ. From him the whole body, joined and held together by every supporting ligament, grows and builds itself up in love, as each part does its work.”

The two metaphors used for the church in the New Testament are the temple and the human body.

In each illustration we see that the church is made up of component parts which, when each plays its role well, build up all the others.

Now as Christians in the free church non-conformist tradition, we understand very well the concept of the priesthood of all believers.

We do not believe that only some members of the body of Christ are there to minister. Each one of us has a gift that we are called to use for the common good.

Some of these gifts are gifts of a service, and some of these gifts are gifts of speaking, as the Apostle Peter makes very clear in his first epistle - 1 Peter 4:9-11.

“Each one should use whatever gift he has received to serve others, faithfully administering God's grace in its various forms. If anyone speaks, he should do it as one speaking the very words of God. If anyone serves, he should do it with the strength God provides, so that in all things God may be praised through Jesus Christ.”

This is, argues Peter, what “loving each other deeply” looks like in practice.

And so, this passage is a challenge to each one of us to ask if we are using our God-given gifts to help others.

Or are we rather so consumed with our own affairs, perhaps literally even our own homes, that we have become distracted from our duty to serve one another?

I heard it said recently that one of the purposes God had in sending this virus was to help the church grow up in using our gifts of speaking and service.

This is perhaps no more clearly evident than in the family.

Are we taking seriously our responsibility to build up our husbands and wives, our children, our parents, or those in our extended family.

Or are these things that we delegate to the pastor, the elders, youth leaders and Sunday school teachers.

And how seriously do we take our responsibility to build up our brothers and sisters in the wider body of Christ?

Maybe it is the gift of teaching, preaching, prophecy or pastoral care.

But maybe it is gifts of the kind that Paul lists in passages like Romans 12 and 1 Corinthians 12:
Gifts of service, encouragement, contributing to the needs of others, leadership, governance, showing mercy, giving generously, administration or offering hospitality.

What is it that each one of us has that we could be using more effectively to build up our fellow believers in Christ, which we are maybe neglecting to use because we've become self-absorbed?

It's interesting to see which companies have done best throughout this present time of quarantine and isolation.

Apart from goldmining companies and those IT companies who market technology like zoom, it is DIY companies, gardening centres, companies which make Warhammer figures or computer games, cycling equipment, sportswear, those marketing home movies.

Because for many people in Britain these things have expanded to fill the void created by the virus.

Perhaps, as Christians, we pride ourselves that we haven’t been tempted into drugs, alcohol or pornography – if in fact we haven’t – but have these softer more subtle things had the same effect of robbing us of our passion for God himself and for his people?

Perhaps this chapter is a challenge to us to examine our lives to look at what, during this time of COVID, has distracted us and consumed our time and money such that we have neglected our responsibilities to one another.

Now of course it is not wrong to be a good steward of one’s own property.

There's nothing inherently sinful about a panelled house, just as there is nothing inherently wrong with DIY, hobbies, gardening, watching films, playing games or whatever.

These things are all God given and part of a healthy balanced lifestyle.

However, when they so focus our time and energy, that we cease to notice the needs around us within the church - and I'm talking not just about the local church but also the global Church of God - much of which is facing extraordinary difficulty at this time in history, then these simple and innocent pastimes can become the very thing that robs us of the fullness of life in Christ, and stops us demonstrating the love and unity with one another in the body of Christ, which is such a powerful magnet to draw unbelievers.

Have we allowed ourselves to become too comfortable, so that we're simply not seeing and hearing, and therefore not responding to the need around us.

That is the challenge of this extraordinary short passage.

Fourth, and finally, we see in this passage, God's extraordinary generosity, mercy and patience with his people.

He doesn't castigate them. He simply points out the fact that they have become distracted and invites them to re-evaluate their priorities.

We often long and pray for God to act, but this passage beautifully illustrates the fact that God often acts in response to prayer through calling us his people to use the gifts that he has already given us to do good in the church and in the world.

The answer to Haggai’s exhortation was not a miraculous intervention from the heavens.

It was simply God’s people taking their responsibilities seriously and getting to work doing his work.

What are the gifts God has given you and me that we are not using to the full?

What responsibilities to God’s people are we neglecting?

What has distracted us and is consuming our time, energy and money at this time of national crisis?

And what is it that we need to do to be like the people of Israel, under Haggai, Zerubbabel and Joshua, who took their responsibilities seriously to do God’s work?

Our final hymn, “Lord of the Church”, echoes these thoughts – why don’t we make it our prayer of rededication?

Lord of the church we pray for our renewing
To bring us nearer what a church should be

Lord of the church we seek a Father's blessing
In Christ to live and love and serve and care

Lord of the church we long for our uniting
True to one calling by one vision stirred

Sunday 31 May 2020

Coronavirus death rates – why some countries are doing so well and others so badly

Last week I was on a conference call with 35 Christian doctors and dentists in our East Asia network. We reviewed the status of the COVID-19 pandemic in each country. The figures are really illuminating.

Taiwan has had a total of 7 deaths, Hong Kong 4 and Mongolia 0. In China, Japan and South Korea the total deaths are much higher at 4,634, 874 and 269 respectively.

But even these latter numbers are tiny when considered on a population basis. China has had 3 deaths per million people, Japan 7 and South Korea 5.

By contrast the UK has had over 38,000 deaths – equivalent to 566 for every million people. This is a hundred times the number of deaths per million in South Korea and over 1,000 times that in Hong Kong. 

For the US the equivalent figures are 103,000 and 319. Again astronomical.

Overall, the US and Europe have been the worst in handling this pandemic thus far. If we disregard those countries with tiny populations less than 200,000 people (St Maartens, Andorra, San Marino, Isle of Man and Channel Islands) the ten countries with the highest covid deaths per million population are all European or North American.

Leading the list is Belgium with 816 death per million followed by Spain (580), UK (566), Italy (551), France (441) and Sweden (435). The next five are Netherlands (347), Ireland (335), USA (319) and Switzerland (222).

Following closely behind them are the rest of the Americas – Ecuador (189), Canada (188), Peru (133) and Brazil (132).

It is now simply impossible to ignore the conclusion that the Far East along with New Zealand and Australia - which have both had only 4 deaths per million population – have handled this crisis far, far better than the Old World.

Furthermore, it has all to do with decisions that leaders in these successful countries have made which those of unsuccessful countries have not made.

What did the successful countries do?

First, they acted quickly, immediately closing their borders, quarantining every suspected case and tracing and testing every contact. They knew exactly how many cases they had in the country and where they were. They identified case clusters and wrestled them to the ground.

Lockdown, along with handwashing and social distancing, helped to limit the spread, but it was the early closing of borders, quarantine and test and trace that contained the virus.

Hong Kong and Taiwan immediately closed their borders because of their past experience with SARS. New Zealand and Australia rapidly followed suit. By contrast official Home Office figures reveal that at least 20,000 people infected with coronavirus entered the UK before lockdown, but fewer than 300 were quarantined. These arrivals would have infected some 50,000 more people given the World Health Organisation’s assessment of an average transmission rate at the start of March of between 2 and 2.5.

Between 1 January and the end of March 18.1 million people entered the UK without any health checks including from coronavirus hotspot countries. Of these, just 273 were quarantined.

Subsequently 15,000 to 20,000 people a day returned to the UK up to the end of April without being subject to the enforced quarantine that had operated in successful countries virtually from day one.

China got quickly on top of their outbreak through a vigorous programme of widespread testing followed by isolation of those affected, backed up by travel restrictions. In Wuhan, where the pandemic started, more than 1,800 teams of epidemiologists, with a minimum of 5 people/team, traced tens of thousands of contacts a day. New Zealand similarly tracked down every single case such that by 30 May there was only one active case left in the country.

Compare this with the UK where testing was abandoned in early March because the number of cases had overwhelmed our meagre testing facilities. With a doubling time of three days the number of cases in the country is estimated to have increased from 11,000 to 1.5 million in the 20 days between 3 and 23 March while the government dithered and talked about ‘herd immunity’ and handwashing.

Second, successful countries protected their vulnerable populations. New Zealand’s total of 22 deaths occurred mainly in two care homes; yes remarkably the disease got into only two care homes. By contrast on 12 May it was reported that more than 8,300 deaths in UK care homes had been linked to the virus since the epidemic started.

We now know that this was because suspected cases in many UK care homes were not even tested, staff were not supplied with PPE and hundreds of people were discharged from hospitals into care homes taking the virus with them. And so British care homes became incubators for COVID-19.

Third, successful countries employed sensible exit strategies. Lockdown measures were not relaxed until the disease had been virtually eliminated and test and trace techniques were sufficient to locate and isolate those few cases which remained.

Again, by contrast, lockdown measures have been lifted when there are still ten of thousands of active cases in European countries including the UK. According to John Edmunds, a professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine, there are still 8,000 new infections every day in England without counting those in hospitals and care homes.

Given that in many people the infection lasts for three weeks (say 20 days) that would mean over 160,000 active cases in the UK at any one time. In China the epidemic peaked at 3,000 cases a day (see p29 here) so we are still over double the number of new cases per day at China’s peak in a country with less than 5% of China’s population.

Worldwide the last three days (28, 29 and 30 May) have seen the largest number of new cases since the pandemic began (116,000, 125,000 and 124,000 – see chart at top of this article).

Test and trace strategies worked in China and New Zealand with hundreds of active cases – but the manpower and organisation required to make them work with over 100,000 active cases in the UK are much higher and our test and trace workforce is not even yet up and running.

Remember that the UK’s coronavirus cases went from 11,000 to 1.5 million in 20 days between 3 and 23 March this year. We are still at the equivalent of 15 March even now. Understandably several advisors of the Sage committee have expressed concern that we are taking our foot off the brake too early and risking a second spike in cases.

These concerns are amplified when we consider that recent studies have shown that, although all those who have had the virus will have antibodies to it, only 5% of Spanish people and 7% of UK people on recent studies have antibodies now.

In other words, 95% of the Spanish population and 93% of the British population are still susceptible to coronavirus infection, at a time when we still have no treatment and no vaccine.

And yet according to official figures there have already been 38,000 deaths in the UK and 27,000 in Spain. If the whole population of both countries were to be infected these figures could rise as much as 15 to 20 times. And as these figures only include those cases proven by test to have the virus the real numbers could be considerably higher.  

This has led Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, to suggest that intensive surveillance, large-scale screening, effective contact tracing, isolation of cases, quarantine for international arrivals and some residual physical distancing ‘is a possible new normal’.

It is perhaps easy to be wise in retrospect, but for many countries in the developed world this crisis is far from over. Lockdown has flattened the curve but prolonged the agony and we may only have witnessed the first act of a very long play.

But the lessons are clear – the trajectory of COVID-19 in any given country is largely a product of how that country handles it. Some countries have done incredibly well – and others incredibly badly.

The important thing is that we learn the lessons for next time. We can be thankful that COVID-19 is only moderately infectious and carries an overall mortality rate of only about 1%. Imagine if it was as lethal as Ebola and as easy to catch as chicken pox. Or perhaps try not to imagine.

Monday 13 April 2020

Trusting God through difficulties – five keys to resilience and perseverance

We all face difficulties in life. What is unique about the coronavirus pandemic is that we are all facing the same difficulty at the same time – although its effect on each one of us is different.

But each family has its own story of illness – mental and physical, chronic or terminal. Each family at some time will face loss – of money, possessions, hopes and dreams. Bereavement, failure and disappointment is part of life for all of us at some point. And we all eventually know the pain of broken relationships or loneliness and isolation – be it temporary or permanent. In addition, for Christians there is the promise that in some way or another we will face persecution (2 Timothy 3:12).

People of various worldviews and faiths all have their explanations for suffering. For Muslims it’s about the will of Allah – it’s all fate. For Buddhists, it has to do with unsatisfied desire – it’s in the mind. For Hindus it is payback for past lives - it’s all karma. And for atheists it’s the product of time and chance – it’s just random molecules.

But for Christians who believe in a God who is at once all-powerful, all-knowing and all-loving – the question is often raised – why doesn’t he do something about it? Surely, he must know and care and be able to deal with it?

Philosophers and theologians throughout the ages have grappled with this question by devising ‘theodicies’ - explanations for why God might allow suffering.

At one level these usually fall in the category of one of four F’s.

First, we live in a fallen world which is damaged by sin. The breaking of God’s relationship with human beings (through our rebellion and indifference) has led also to a breaking of our relationships with each other and with the planet. War, disease and natural disasters are to be expected in such a world. The whole world is ‘groaning’ (Romans 8:22).

Next is the effect of free will. God has granted human beings, and indeed the devil himself, the ability to make choices. How much of the difficulty in our world results from people (or demons) making bad choices or failing to make good ones?

Third, we need to see difficulties through the eyes of faith. God has higher purposes in suffering which we, from our limited human perspective, may be unable to discern. Suffering produces perseverance and perseverance produces character, as the Apostle Paul reminds us. (Romans 5:3, 4).

Finally, we need to see suffering in the light of the future. God has unfinished business with this planet and its inhabitants and his intention is to create a new heaven and new earth where there is no suffering (Revelation 21:1-4). Everything will eventually be put right. But he is in no hurry as he wants to give people a chance to turn to him before it is too late. (2 Peter 3:9) And pain and difficulties, as CS Lewis reminds us, are his megaphone to a deaf world.

But the Bible is also a book for life travellers more than armchair philosophers; and travellers ask different questions: How do I get over this next hill or obstacle? Which route do I take at this fork? Don’t expect to know the answers to all life’s mysteries and especially what God’s purposes might be for you personally through them.

And so, we would expect Scripture to be replete of practical advice for travellers – and it is. 

Psalm 13 is a great example, worthy of thousands of words. Facing problems? Keep praying (Psalm 13:1-4), trust in his unfailing love (5), rejoice in his salvation (5) and sing the Lord’s praise (5). All of these are life-transforming exhortations.

But in this post, I want to draw to your attention five keys to resilience and perseverance from one of my favourite chapters in the Bible – Hebrews 12. I hope they will be as much help to you as they have been for me when I need something a little more. Hebrews 12 is a feast of practical instruction – and its appeal is to use our minds to think our way out of bitterness, despair and self-pity.

1.Consider those who have gone before (Hebrews 12:1-4)

The chapter starts with the word ‘therefore’ calling us to look back at what has just been said:

‘Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us’ (Hebrews 12:1,2)

Who is this great cloud of witnesses? They are the heroes of faith whose names are listed in Hebrews 11 – Abel, Noah, Abraham, Isaac, Jacob, Moses, Gideon, David, Samuel and the prophets. Many of them won great victories – but none had a life devoid of suffering and struggle.
Some of them, we are told, were ‘tortured… faced jeers and flogging, chains and imprisonment. They were put to death by stoning… sawn in two, killed by the sword… persecuted and mistreated.’ (Hebrews 11:35-37).

In comparison many of own burdens pale into insignificance.

But most of all the author bids us to consider Jesus Christ himself, who ‘endured the cross, scorning its shame’ in order to win our salvation. In fact, he put himself through this ordeal for ‘the joy that was set before him’ – the joy of saving us, and of winning us for himself.

Jesus, in his struggles on our behalf, always had the end in view and this is what encouraged him to press on. In the same we need to remember that nothing done in the Lord’s service is ever in vain (1 Corinthians 15:58) and that our labours for him are fruitful (Philippians 1:22) even if there are times when we cannot imagine the fruit, let alone see it with our own eyes.

‘Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.’ (Galatians 6:9)

Have we ‘resisted to the point of shedding our blood’? (12:4) Not many of us. So, let us consider those who have gone before – especially Jesus Christ – and think about what they went through before feeling too sorry for ourselves. Let’s instead ‘throw off everything that hinders and the sin that so easily entangles’. (12:2)

2.Endure hardship as discipline (12:5-12)

‘Endure hardship as discipline; God is treating you as his children. For what children are not disciplined by their father?’ (Hebrews 12:7)

God uses the hardships we face to build into us the qualities we need to be his effective disciples. ‘Perseverance produces character’ says Paul (Romans 5:4). ‘Consider it pure joy when you face trials of many kinds, because you know that the testing of your faith produces perseverance’, says James. (James 1:2,3)

Just as training hones the athlete and grit produces a pearl in an oyster, so God uses trouble and difficulty to shape and improve us, so that we are more useful to him. This is a mark of his love for us.

So, ‘do not lose heart when he rebukes you, because the Lord disciplines the one he loves’. (12:5). Just as our parents’ discipline is a mark of their love for us, so when God brings hardship into our lives it is with a higher purpose of moulding us into his image.

‘No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.’ (Hebrews 12:11)

Often if we are honest, we find ourselves taking exactly the opposite view and assuming that God cannot love us because of what he has allowed us to go through – but in fact he never promised us that life would be easy. Rather Jesus said to his disciples, ‘In this world you will have trouble’. (John 16:33)

How we love to hear the tender words of Jesus, ‘Come to me, all you who are weary and burdened, and I will give you rest’ (Matthew 11:28). But sometimes we actually need him to be tougher with us. Jesus said some unbelievably tough things to his disciples, which they badly needed to hear for their own good.

When Jeremiah was complaining to the Lord about how difficult things were for him as the Lord’s prophet he received a salutary telling off:

‘If you have raced with men on foot and they have worn you out, how can you compete with horses? If you stumble in safe country, how will you manage in the thickets by the Jordan?’ (Jeremiah 12:5)

Effectively God is saying, ‘toughen up. If you think this is bad how are you going to cope with what is coming?’

God disciplines us through the hardships we face in order that he can use us more effectively in the future.

No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.’ (12:11)

So, when we face difficulty a good question to ask is, ‘What is God teaching me through this? What qualities is he building into me as I rise to this occasion?’

3.Make every effort to live in peace and be holy (12:13-17)

Sometimes we can be tempted to grumble against God when we face difficulties. In the Book of Malachi God accuses his people of saying ‘harsh things’ against him. (Malachi 3:13). ‘What are these harsh things?’ they ask. God replies that it is when they say, ‘it is futile to serve God. What did we gain from carrying out his requirements’?

How often we fall prey to this – pouring scorn upon our Lord and Saviour because we don’t like our personal circumstances.

This part of Hebrews 12 warns us of the danger of using hardship as an excuse to stop being serious about our discipleship. Esau is cited as a sobering example in throwing away his inheritance just because he was tired and hungry after a hard day’s work. (12:16)

We need to ensure that we do not fall into bitterness, sexual immorality of fighting with others out of spite for God or because we think that what we are going through gives an excuse for such behaviour.

Living holy lives and living in peace with others are no less our duty when times are tough.
As Peter reminds us, we ‘ought to live holy and godly lives’ as we ‘look forward to the day of God and speed its coming’. (2 Peter 3:13)

This is crucial if we are to commend the Gospel to others. Let’s not use tough times as an excuse for sin.

4.Remember what you have been saved to (12:18-24)

The writer here draws a contrast between the Old Covenant made by the Israelites on Mt Sinai and the New Covenant sealed with the blood of Christ on the mount of crucifixion.

The promised rewards of the former were dependent on obedience to God’s commands (Exodus 19:5, 6) and there were accordingly warnings, commands and punishments for disobedience (Deuteronomy 28:15-68). But there is no condemnation for those who are in Christ Jesus (Romans 8:1).

By contrast, the New Covenant is based on God’s grace – his unmerited favour to us through Jesus paying the price for our sins on the cross.

We look forward to the ‘heavenly Jerusalem’ (12:22) and a glorious eternity with God. Christians often forget that the rewards in the Christian life are almost entirely in the future.

And it is the glories and delights of heaven that put the sufferings of this life into perspective.

No eye has seen, no ear has heard, and no human mind has conceived what God has prepared for those who love him. (1 Corinthians 2:9) In the light of the eternal glory that is coming, our troubles on earth, however bad, are but ‘light and momentary’ when seen from this perspective. (2 Corinthians 4:17)

5. Remember what you have been saved from (12:25-29)

Keeping our troubles in perspective against the joys of heaven is sobering, but so also is seeing them against the horrors of hell, eternal separation from God.

If God was simply a God of justice, then he would have eliminated humankind at the moment Adam and Eve first sinned. But he is thankfully also a God of mercy, who delays the judgment we all deserve to enable us to repent.

We cannot stand safely in his presence unless we are clothed with the ‘righteousness of Christ’ (2 Corinthians 5:21) because ‘God is a consuming fire’. (12:29)

The author of Hebrews here reminds us about the fate of people at the time of the Exodus who turned their backs on God.

How much worse will it be if we reject him now, after the coming of Christ.

The threat of coronavirus is nothing compared to facing Jesus Christ unforgiven on the day of judgement so we need to be thankful, reverent and humble before him. (12:28, 29)


Are you tempted to fear, despair or give up? Consider those who have gone before. Endure hardship as discipline. Make every effort to live in peace and be holy. And see things in an eternal perspective – always remember what you have been saved to and what you have been saved from.
Let’s take these five keys to resilience and perseverance to heart as we negotiate these current difficulties.   

Wednesday 1 April 2020

‘Green zones’ for the vulnerable may be a cheap and effective option for preventing coronavirus spread in low-resource settings

US and Western Europe have so far been the hardest hit by the coronavirus with over 80% of cases worldwide - but there’s good reason to think that the Developing World will ultimately suffer most. 

According to a recent report, 40 million lives may be at risk this year (see my previous post here).

Controlling spread of the virus there will be a very different prospect in low-resource settings. What techniques are likely to work best?

A new paper from the London School of Hygiene and Tropical Medicine (LSHTM) is advocating so-called green zoning – rather than quarantining those already infected by the virus (red zoning), those individuals who are both unaffected and vulnerable are protected by being separated off from the rest of the population.

This may appear counterintuitive – after all developing countries have a much lower proportion of older people – in Wales, for example 21% are over 65 whereas in Ethiopia only 3% are.

But the authors identify three reasons why populations in the developing world are likely to be more vulnerable to COVID-19.

First is reduced social distance. Larger intergenerational households, intense social mixing between the young and elderly, overcrowding in urban slums and displaced people’s camps, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals – all lead to higher transmissibility of the virus.

Second is high numbers of vulnerable patients. Non-communicable diseases (NCDs), like diabetes, hypertension and chronic respiratory disease, undernutrition, tuberculosis and HIV all make it more likely that coronavirus infection will push people over the edge.

Third is weaker health services. Fewer hospital beds, fewer health professionals, less intensive care facilities and poorer infrastructure and healthcare delivery systems. Inadequate water and sanitation make it worse.

The strategies that have worked so effectively in containing the virus in East Asian countries like Singapore, Hong Kong and South Korea – widespread testing and meticulous contact tracing – are very resource-intensive and less easily replicable in low-income and crisis settings.

Lockdowns are also likely to be very harmful for societies in which most live from hand to mouth and have little if any savings. And when people are stretched beyond their ability to cope they are less likely to comply with control measures.

There is also little prospect of scaling up intensive care to the levels required and isolation of cases in dedicated high-intensity wards might offer little benefit as most transmission would still be due to mildly unwell people spreading the virus to close contacts and family members.

For all these reasons, it may be therefore a better use of resources to focus on protecting the vulnerable.

In Ebola epidemics, the aim of isolating the ill into a contaminated ‘red zone’ is primarily to protect the healthy. But with COVID-19, the red zone is everywhere, so it makes more sense to protect those more likely to suffer fatal illness from the rest of the population who are much more likely to survive the infection.

The risk of coronavirus infection increases with age with a particularly high risk among those aged over 70 (or even 60 in low-resource settings) and/or living with NCDs and other immuno-suppressing conditions.

The authors suggest three options for shielding high-risk community members – house-hold level, street-level and neighbourhood or sector level. In the first two arrangements healthier members of the high-risk group could care for those with disabilities.

Stringent infection control measures should operate with all options. The green zone’s boundaries should probably remain virtual, but a single physical entry point, with handwashing facilities, should be established and food and other provisions should only be exchanged through this point.

Given that it may be difficult to isolate at-risk people for long periods the strategy should be discontinued as soon as safe to do so. This could be ascertained by serological testing, which is likely to be very cheap once widely available.

Detailed guidelines need to be developed and other feasible, high-yield interventions should be undertaken simultaneously (eg. staying home if sick, limiting public transport use, reducing super-spreading events at funerals or other mass gatherings, promoting hand-washing, soap distribution).

In the meantime, those who develop symptoms of COVID-19 (fever, continuous cough) would be tested (if possible), isolated and quarantined for 14 days in the usual way (red-zoned), along with their close contacts (family members).

This approach would enable the rest of the community to carry on with normal life with frequent handwashing etc (maybe we could call this the blue zone!), knowing that if they did catch the virus they would be very unlikely to suffer serious symptoms or die. Meanwhile, immunity would build up gradually in the general population.

This simultaneous green zone/red zone approach also has the advantage of avoiding the negative effects of lockdown on the economy and normal life, whilst protecting those most vulnerable, until a time when a vaccine is available to confer longer-lasting protection.

Longer-term, as with other viral illnesses like influenza or HIV, it will be vaccines or antiviral therapies that will best protect people in low-resource settings – but in the meantime, in the absence of these, protection in green zones seems a sensible, practical and low-cost option for reducing mortality.

The protection of the vulnerable resonates well with Christian ethics – and green zones operate on the ‘Passover principle’ where those located in safe places (marked by blood on the lintel) were kept from harm. With Easter coming up soon – this may be a good way to motivate faith leaders, who are often the most trusted voices in developing world communities, to protect their flocks.  

Saturday 28 March 2020

The Developing World and not the West will bear the brunt of coronavirus – but acting quickly could save over 30 million lives this year

With 80% of coronavirus deaths in Western Europe the focus of the world’s media has understandably been there. The UK had 260 deaths today and has had over 1,000 deaths overall.

But COVID-19 is affecting 199 countries and territories around the world.

Among these are 27 countries with between 3 and 40 deaths today (where the UK was on 14-19 March) and 28 countries with 1 to 2 deaths today (where the UK was on 5-13 March) – so that’s another 55 countries that on deaths per day are only 9-23 days behind us.

Of those 55 countries over 20 are in the developing world. At the current rate of spread – a 12% increase in global deaths per day - we would expect to hit 100,000 total global deaths by 7 April, 500,000 by 21 April and 1 million by 28 April.

But if we were to run this forward to the end of the year what would we find?

A new report this week claimed that doing nothing to combat the virus would leave the world facing around 40 million deaths this year.

But they also claimed that up to 95% of these could be saved if countries act quickly.

Researchers from Imperial College in London have looked at the impact of the pandemic in 202 countries using different scenarios based on data from China and Western countries.

Their conclusions?

If countries adopt strict measures early (at a stage where there are only 2 deaths per 1,000,000 population per week) - such as testing, isolating cases and wider social distancing to prevent transmission to more people - 38.7 million lives could be saved.

But if these measures are introduced later (at 16 deaths per 1,000,000 population per week) the figure could drop to 30.7 million.

On the other hand, social distancing alone would save only 20 million lives.

The effects of the pandemic are likely to be most severe in developing countries – communication is worse, health facilities are poorer, there are fewer health professionals and a high incidence of chronic infections (like TB) and noncommunicable diseases (heart disease, lung disease and diabetes).

Different demographics mean that older people make up a smaller proportion of the population (21% of people in Wales are in the vulnerable over 65 age-group but only 3% in Ethiopia) but this is more than compensated for by the larger populations and the increased risk posed by larger multi-generation households.

The ten most populous countries in the world include India (with 1,380 million people), Indonesia (273m), Pakistan (220m), Nigeria (206m), Bangladesh (164m) and Mexico (128m). That’s 2,371 million people – about a third of the world’s total population – in just six countries.

The ten next most populous countries include Philippines, Egypt, Vietnam and Democratic Republic of Congo (DRC) with a combined population of over 400 million.

This Is over twice the population of Western Europe (currently 195m).

There will be 25 times more patients needing critical care than beds available, compared to seven times more in high-income countries, the report says.

Seeking people’s compliance with infection reducing measures like social distancing in a wealthy and technologically advanced country like the UK where education levels are high and communication easy - everybody can be reached easily by text and social media - is one thing.

Achieving this in many developing countries where infrastructure, transport and communication systems are poor by comparison, literacy levels relatively low and where governments and police are more likely to be corrupt, unaccountable, under-resourced and unmotivated is another prospect altogether.

According to the BBC, after the lockdown was announced in India this week, people in Delhi and the financial capital, Mumbai, quickly thronged shops and pharmacies amid fears of shortages. 

Meanwhile, millions have been left jobless and without money as a result of the shutdown.

It has also sparked an exodus from major cities, where thousands of migrant workers are setting out on long journeys back to their home villages after transport was stopped.

India ranked only 80th in Transparency International’s world corruption perception index in 2019. Indonesia, Pakistan, Mexico, Nigeria and Bangladesh ranked even lower at 85th, 120th, 130th and 146th equal respectively among the 180 countries included.

Corruption means that nothing can be achieved quickly and efficiently. But as the virus spreads, only the most draconian measures will lessen the impact and the countries least able to protect themselves will be among the hardest hit.

Prof Neil Ferguson, from Imperial College London and author of the report, said: ‘Our research adds to the growing evidence that the COVID-19 pandemic poses a grave global public health threat.’

He adds that ’sharing both resources and best practice is critically important if the potentially catastrophic impacts of the pandemic are to be prevented at a global level.’

Strategies to suppress the virus will need to be maintained in some way until vaccines or effective treatments become available to avoid the risk of another epidemic.

The West has huge expertise and now experience in battling COVID-19. But what will we do to help the less-advantaged global south as they face an even bigger challenge?

One thing is clear – if interventions are to have an impact and go any way to saving 95% of the 40 million who could die this year then we must act quickly. In a matter of weeks, it could be too late.

We cannot wait as long as we did in the West before acting – as developing countries do not have enough hospital beds and oxygen, let alone ventilators to provide back up if prevention of spread of the virus is unsuccessful.