Only a fifth of countries provide sick pay — the big challenges for work in a pandemic

From a personal point of view and from an economic point of view, this is nothing short of potentially disastrous for people's livelihoods.

Just one fifth of countries have sick pay in the time of coronavirus.

Victor J. Blue/Getty Images

Making sure that sick people get the care they need and don't infect others is one of the key planks of containing COVID-19 - but the majority of the world's workers have little choice about putting in a shift, even if they feel unwell.


This is one of the worrying findings of a survey released by the International Trade Union Congress, which surveyed its members in 86 countries around the world to monitor government and employer responses to the pandemic.

According to the study, only 21% of countries are providing sick leave for all or some workers. The countries polled represent a swathe of the world's most powerful economies, including 28 out of 36 OECD countries and fifteen G20 countries.

Reflecting the severity of the situation, over half of all countries surveyed (53%) were containing the spread of the coronavirus with national lock-down measures such as the closure of schools and non-essential businesses.

This unprecedented situation is sending shockwaves through the world of work. To soften the blow, governments were most likely to opt for the five policies below, according to the ITUC:

  • Provision of free health care - 50% of countries
  • Employment protection for those self-isolating - 34% of countries
  • Tax relief for businesses - 31% of countries
  • Paid sick leave for a period of self-isolation - 29% of countries
  • Bailout funds for business or sectors - 29% of countries

To find out more about the exceptional challenges facing workers, and how both businesses and governments can best safeguard livelihoods, I spoke to Sharan Burrow, General Secretary of the ITUC. Below is an edited transcript of the conversation, which you can listen to in full here. Subscribe to World Economic Forum's COVID podcast here.

Where are you, and what is daily working life like for you right now?

I'm now working from home in Brussels. All our staff are working remotely except those of our security team and the occasional IT role. It's a challenge now to manage, a global office of people in their own homes. The technology we have now really does play up the opportunities, but it also highlights the costs and potential risks of people being atomized from their place of work.

What have you found to be the single toughest nut to crack in this situation?

The mental health cost of this crisis will play out in the months to come - so I think just making sure people are connected and stay in touch is critical. And those human interactions we take for granted on a daily basis - passing someone in the coffee corner, having a quick briefing, whatever the daily rhythm might be - you don't realize how efficient those interactions can be until you're trying to manage that remotely.

And for people with young children, this is an incredibly difficult time. Balancing work and family is a whole new realm of challenges. So from a personal point of view and from an economic point of view, this is nothing short of potentially disastrous for people's livelihoods and indeed for stable economies.

What can workplaces do to better support parents during this time?

We have to think about how to provide a mix of work and parenting that works, because children matter as well. Their mental health matters, and their need for support and activity, scheduling and even just attention is very important for their own health and development.

You have to be conscious that parents can't be online and available to work 24/7. People must feel able to say, I can't work for these hours but I'm available at these times.

What impact do you expect this crisis to have on the global jobs market?

The imbalance of the global economy is now being felt. First of all, we should say thank you to those businesses who have kept their staff on, who have made sure that they have income security and a sense of job security in the medium to longer term. But there are many businesses who have simply taken an opportunity to lay off staff. In some cases, they are taking government support and still laying off staff.

So there is a divide in the business community. There is one set of businesses who say, we need to look after our workers, and we need to work with the unions to make sure that the humane aspects of this crisis are dealt with as positively as possible. There have been joint calls to government to support people - first and foremost, workers on the frontlines. Our health workers, transport workers, workers in supermarkets and related services, care facilities, schools where they're still operating; there are high-risk safety issues for workers in those situations, and we owe them a huge debt of gratitude.

But beyond that, where the factories and retail outlets and services are shutting down, people often have far too little sick pay, if any at all. Wage and job guarantees are lacking. The International Labor Organization (ILO) says we could lose up to 25 million jobs worldwide – and depending on the timeframe, it could be worse than that.

coronavirus job lossesMajor job losses are expected in travel and tourism. Image: Statista

So we have to do everything to minimize the fallout. First of all, only 50% of countries are providing free public healthcare – that is a glaring gap. And if that's the case in the richer world, then in developing economies where the virus is only just starting to spread, the health fallout could be disastrous. So if it's a mix of public and private testing and care, it has to be run on public health principles, it has to be available to everybody and it must be a partnership.

And where businesses have been forced to close their doors, of course not everybody can work from home. In fact, 50% of the world's population aren't connected to the internet. Looking at the responses to-date, mostly from Europe, the US, Australia and a few other countries, we have seen quite a lot of initiatives to support small businesses in particular.

But when you then consider that only 21% of countries in the richer world provide paid sick leave for workers, then that's a disaster of humanitarian crisis levels. That is unconscionable.

Beyond paid sick leave, people need income security. If you're not a direct employee, you're still going to need income, whether you're self-employed or working in the informal economy. We certainly need to see income support. The guaranteed packages to date have to be expanded.

Then, of course, in terms of job or employment protection, only around 15 of the G20 countries have given guarantees about supporting jobs. This has to be in the next wave of measures under consideration by all governments. We've asked the G20 governments to look at measures that support workers and small businesses in partnership, because you can't just give money to businesses if it then doesn't flow to their workers. There has got to be some sort of criteria, some conditionality, and some direct investment in working families themselves. That's the best guarantee for the real economy. We need to look at the economy as a whole, taking it from the perspective of working people and their families, which wasn't done in the 2008/2009 process.

Are there any countries that you feel are really getting this right?

Yes - those countries who have looked at the key elements of paid sick leave and income guarantees for all workers, and what the mix of that should be. The best of those packages have been negotiated with unions in Europe and the UK. Outside of Europe, places like New Zealand, Singapore and Argentina have done a very good job of making critical economic decisions, and they have looked to be inclusive of all people. In some Latin American countries we've also seen some measures to include the informal sector - particularly those who work in farming communities. That's a very good thing.

Our message is very simple: you have to look at guaranteed paid sick leave. This is a health crisis. It's different to the crisis of 2008/9; this one started with a human dimension, in the real economy, and is now spreading to the financial sector. In 2008/9 we saw the speculative economy simply spiral out of control, and that caused a crisis in the real economy. We took huge hits - there was high unemployment, and inequality escalated - but our economies didn't shut down. This is a very different environment and we need to think about the short-term timeframe.

What are the package deals? We know what they should involve; support workers with income support and job protection. We can support small businesses and make sure that we're able to pick up an economic base in the medium term. But then from the medium to long term, we're going to be looking at post-reconstruction policy frameworks. We haven't really had to deal with that since big shocks like the Great Depression or World War II, which was followed by the Marshall Plan and debt swaps. Now, of course, we need to design policies to align with investment in people and the environment.

But above all, the longer-term perspective is about rebalancing economies. What we don't want is an unbalanced economy where you can't get essentials like healthcare products and food because they're produced in one group of countries and not in a balanced fashion around the world. We have to look at how to build a better economy alongside the convergent crisis of the environment – which is not going to go away.

COVID-19 intersects with the underlying inequality crisis that was already fragmenting our societies and creating an age of anger along with the challenges posed by technology. In some ways, this experience will tell us what we need to do to get it right – so that people are connected and we're not abusing technology at the cost of both people's physical and mental health.

These are big challenges. But going forward from the medium to the longer term, we need more social dialogue in order to design a better and more balanced economy.

Of course, right now we're all focused on the short term, because dealing with all the areas of crisis that are converging is critical at the moment. Most importantly, we must keep the central supply chains — for healthcare products and food, for example — open. Mindless border closures, without thinking about the consequences, have made this more difficult than it should have been.

The second area of challenge is the supply chains for non-essential items. With sectors such as retail electronics, for example, closing down in the short term, we risk even greater devastation than is caused by the current dehumanizing exploitation of supply chains. If you're talking about a million people in Bangladesh in the textile sector alone, and multiply that across all the Asian, African and Latin American supply chains in those sectors, then you get a picture of the potential human cost. There is also a risk that much of that business won't come back quickly. So it is a time for social dialogue, and for rapid response from governments. The multilateral environment has been found wanting; we've all been saying it's in crisis, but now it's hardly there at all. So the G20 meeting will tell us who's going to act and who's not, and what we can do with businesses and workers' organizations to support those governments who want to act in the interests of their own countries, but also vitally in partnership with the developing world, which will be devastated.

Has your organization heard stories of people who have no choice but to turn up to work sick, and who then presumably spread the pandemic even further?

Oh, it's everywhere. If people work in the informal sector, if they're day workers, if they're in factories that are still open and there's no paid sick leave, no income guarantee, then they have no choice. You have to feed your family, so you're going to go to work. And that is a recipe for extending the reach of the virus beyond the containment period that we're all working towards right now.

What is your message to G20 leaders as they meet virtually to discuss the crisis?

It's very simple. The emergency plan should be to share our wealth and to re-establish a social contract that includes paid sick leave and income guarantees. And that means, of course, wages - but it also means those who are in self-employment, freelancers, platform business workers and the informal sector. This is a time for social protection generally and for investment in vital public services, beginning with health. The G20 countries are providing free public healthcare, and we have seen the stresses and strains on countries like Italy and Spain and others. Imagine what it's like when people simply can't afford to go to the doctor – even in countries like the US. So social protection, public services, health, education, care - these are the issues of design for the future that we need to get right.

If we're not to see this level of devastation with the continued inequality that we were already facing and, of course, if we are to do something about the climate emergency, which won't go away, then we have to marry the design of better economies with action on both the climate and COVID-19, along with those vital areas of employment protection. We need a new social contract. This crisis is showing the cracks in our world; if people are vulnerable, then the economy is vulnerable.

Times of crisis have historically also been opportunities for change. Are you optimistic that as we emerge from this, it could be a chance to create a better economy?

I can see how we could use this opportunity to design a better world, but we need both national and multilateral institutions to make it work. I was at the table in 2008, 2009 and 2010, when the G20 governments - along with the International Monetary Fund and other institutions - took decisions that were about people, about employment and about maintaining jobs, as well as, of course, stabilizing the economy.

Now - we didn't get it right. We certainly didn't get the rules of the financial sector right. We were worried about the too-big-to-touch banks, and we didn't solve that. Now we've got the too-big-to-touch monopolies in the global tech sector, and we haven't begun to solve that. And everything in between is also a replication, therefore, of the human cost involved when governments have failed to regulate the labour market. So we have now 60% of the global workforce actively working informally. And that means, of course, those working in platform businesses as well as those informal jobs with no rights, no minimum wage and no social protection that are emerging in our supply chains. That has to change.

It can change if people can sit at the table. But going back to the financial crisis, many of the key G20 leaders at that time - people like Gordon Brown, Barack Obama, Kevin Rudd and Luiz Inacio Lula da Silva - these people have disappeared from our ranks, along with their experience. They acted together. What we're seeing now is a kind of retreat, which might be understandable emotionally, but it's not going to help us. Solidarity and sharing and deciding on how you protect people – both within nations and globally - is absolutely critical at the moment. We are trying desperately with some of the business community to rebuild that social dialogue with labour organizations, businesses and governments. But while it works tremendously well in some democratic countries, by and large it's not working in the majority of the world's countries and it's not working globally. And we have to come back from that.

People are aware of the extraordinary work going on in the healthcare sector right now. But what about the forgotten heroes - people who might be exposing themselves to risk to keep the wheels of our societies turning? Who are the vulnerable workers, and what can be done to protect them?

Healthcare workers are very vulnerable, because the lack of personal protective equipment has really caused much more infection amongst some of those frontline workers than should have been the case. Hopefully that's turning around, but I know from our unions in many countries that it's still at critical levels.

But then we also need transport and supermarket workers, for example, to keep the show going. People should thank these workers because if you can't buy food, then you can't keep your family sustained and healthy. There's an extraordinary set of challenges for them. And of course, there are essential services, but there are also people running homeless shelters, and shelters for victims of domestic violence, which, sadly, is on the increase. We need more safe havens for women and children. There are people working in aged care facilities looking after the most vulnerable group of people. And of course, there are all of the services that surround each of those sectors, because you can't run these operations without supplies and service support. These people are all heroes.

The terrible irony is often that those sectors, particularly on the frontlines of care, are dominated by women who are among the lowest paid workers in our communities. So when we come out of this there are questions to ask about who we value and who we are prepared to pay decent wages for the dignity of decent work, too. It's been an unresolved issue for a long time. It's about feminized industries and unequal pay and a lack of recognition. But I think there's a chance in the medium to long-term to say we must stop this, we must value those workers and we must pay them appropriately - with notable exceptions.

There is still a lack of women sitting around the table at leadership meetings like the G20. Do you think that is playing a role in some of the things that are just not being spotted in the response to this crisis?

Oh, without question. I think there's a lack of tables right now. There's no question that women's leadership is critical, because it will bring to the forefront the areas where women hold together the fabric not just of our societies and our communities, but also our economies.

There are, of course, the immediate packages [from governments] to give people security by protecting their jobs and incomes. But there is also, as I have indicated, medium to longer-term planning to undertake. The challenge there is to ask: how do we build better economies? How do we learn to balance sustainability, inclusiveness and decent working conditions, where people don't walk away from the human and labour rights of workers and instead build a future where the world is more equal but also much more stable?

Let's fast forward to an optimistic scenario. It's March 2021. The economy has recovered. What do you hope will have changed to make it a better economy for workers?

I hope that we can get beyond the dominant politics of leaders not putting people first. Of course, we want economic stability. We are working very closely with those voices in business who are dignified and responsible, despite their own challenges, in their concerns for their workers, and for government policies that are balanced and justified in these times. But we want an end to the profit-at-all-costs mentality, because if we don't build an economic future within a sustainable framework in which we are respectful of our planetary boundaries and the need to change our energy and technology systems, then we will not have a living planet for human beings.

And we must ensure that this design is inclusive of universal social protection. The world could fund it right now - and yet 70% of the world's population has no social protection. It must be respectful of public services rather than simply trying to profit from them. So public support for people and of course, of the social dialog that makes it possible for us to get the balance right, are crucial. If you've got workers, employers and civil society at the table with governments at all levels, then you can design the kind of future that takes into account the right priorities for people, for the planet and of course, for stable economies.

Reprinted with permission of the World Economic Forum. Read the original article.

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Reactive oxygen species (ROS) accumulate in the gut of sleep-deprived fruit flies, one (left), seven (center) and ten (right) days without sleep.

Image source: Vaccaro et al, 2020/Harvard Medical School
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The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

"We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

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fly with thought bubble that says "What? I'm awake!"

Image source: Tomasz Klejdysz/Shutterstock/Big Think

The experiments

The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

"We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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