Fostering a sustainable pediatric cardiac workforce in the developing world during the current COVID-19 pandemic

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: The majority of the world’s population with congenital heart disease (CHD) does not have access to corrective surgery, including 70% of those living in sub-Saharan Africa. Communicable diseases still cause significant mortality in low- and mid-income countries (LMICs), but increasingly, the burden of non-communicable diseases (NCD), such as CHD and rheumatic heart disease (RHD), has increased, creating great strain on fragile healthcare systems. The number of pediatric cardiac centers in LMICs is grossly inadequate to provide the necessary care. The unprecedented COVID-19 pandemic due to SARS-CoV-2 has only worsened the global disparities, and unfortunately has set the clock back by a few years. There has been an interruption of foreign missions and collaborations, which has affected the care of children with heart disease, and which will further increase the number on the waitlist. Much of the hard-won progress made in improving neonatal, infant, and maternal mortality may be lost due to the pandemic. Time is running out for the ambitious sustainable development goals set for 2030. At present, only 1% of developing world are vaccinated against COVID-19 with the poorest countries not expected to receive vaccine until 2023. This intervening time provides a crucial opportunity to apply “frugal innovation” by training and equipping local teams and policy makers. We employed a Gap and SWOT analysis to identify the steps needed to work towards improving children’s heart care in the developing world, all while using lessons learned from the COVID-19 pandemic.