Providing much-needed personal protective supplies to low- and middle-income countries could cost billions of dollars, but could keep millions of people from dying from COVID-19 and prevent further spread of the disease around the world, according to a new study by Johns Hopkins Medicine researchers.

Personal protective equipment (PPE), including gowns, face shields, face masks and gloves, keeps doctors, nurses and others on the front lines safe by decreasing the transmission of SARS-CoV2, the virus that causes COVID-19. More than 80% of the world’s population lives in low- and middle-income countries where fragile health systems with few resources make health care workers vulnerable to COVID-19. In a paper published Oct. 9 in the journal PLOS ONE, Johns Hopkins Medicine researchers predicted the health and economic consequences of the immediate investment in PPE for health care workers in these countries.

Based on a decision-analytic model (a common model used by scientists to predict outcomes) that the researchers developed, they found that an investment of $9.6 billion would adequately protect health care workers in all low- and middle-income countries. This intervention would save nearly 2.3 million lives in those countries, costing $59 to avoid each new health care worker-associated case of COVID-19 and $4,309 to save the life of one health care worker. Overall, the societal return on investment would be $755.3 billion, a nearly 8,000% return.

“With significant financial challenges, investment in PPE may seem like a huge drain — but is it?” asks Junaid Razzak, M.B.B.S., Ph.D., director of the Johns Hopkins Center for Global Emergency Care, a professor of emergency medicine at the Johns Hopkins University School of Medicine and an author of the paper. “We addressed this question and show that providing PPE for health care workers is the right thing to do and a smart thing to do.”

The researchers estimate that in scenarios where PPE remains scarce, 70% to 100% of health care workers may get infected in spite of nationwide physical distancing policies. The researchers say even minimal workforce depletion due to illness, death or absenteeism could threaten the stability of health systems in low- and middle-income countries.

“Maintaining a stable health care system that serves patients well requires a large number of health care workers who are free from illness and well-protected on the job,” says Nicholas Risko, M.D., M.H.S., assistant director of the Center for Global Emergency Care, an assistant professor of emergency medicine and an author of the paper. “We hope this knowledge supports efforts to produce, purchase and distribute PPE to vulnerable front-line staff in these countries, which will avoid a massive weakening of the health care workforce.”

Razzak and Risko are available for media interviews about the cost to provide PPE to low- and middle-income countries, the return on investment and the importance of taking such steps.