Coronavirus testing is barely scratching the surface in much of the developing world.

By the numbers: Americans are more than 200 times as likely to have been tested as people in countries like Nigeria and Somalia, according to data compiled by the International Rescue Committee (IRC).

What they’re saying: “You’ve seen how difficult it was to get testing going here, so imagine what it’s like in a country that’s much poorer with much weaker state infrastructure and much weaker science infrastructure,” David Miliband, the IRC’s CEO, tells Axios in an interview.

• The lack of tests in many poorer countries can be attributed to political dysfunction, poor infrastructure and shortages of testing kits and lab capacity.
• In the Democratic Republic of Congo, Miliband notes, samples have to be transported to labs in Kinshasa. That’s no easy task in a country where very few cities are connected to the capital by road.
• What to watch: Many poorer countries that are now easing lockdowns may not have huge numbers of recorded cases, but also lack sufficient testing to know whether their outbreaks are under control.

Breaking it down: Big proportions of tests are coming back positive in countries like Somalia (45%), Afghanistan (30%), Chad (29%) and Mexico (29%), suggesting many cases remain undetected. Roughly 15% of tests in the U.S. and 6% in Germany return positive results.

• In Yemen, Tanzania, Northeast Syria and even Nigeria, which is home to 200 million people, so little testing is being conducted that the available data is of limited value.
• “We’ve got countries where there are hardly any tests going on at all,” Miliband says, “and we’ve got countries in South Asia where we’re getting enough testing to be very worried.”
• In Pakistan, he notes, it took 45 days to reach 5,000 cases, but just two more for the tally to double to 10,000.

What’s next: It’s far cheaper to prevent outbreaks from spreading within countries than to respond to massive outbreaks later — particularly given the risk they could spread around the world, Miliband says.

• Even the basics — taking temperatures and isolating those who may be ill — require funding that is scarce in many countries.
• The IRC is calling on Congress to include $12 billion for the developing world in its next round of COVID-19 funding.

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