Can you explain why the other 2 billion living in the region, people mostly living in terrible conditions with very little healthcare as it compares to say Ital

Can you explain why the other 2 billion living in the region, people mostly living in terrible conditions with very little healthcare as it compares to say Italy, aren’t all dead ? Why arent they having massive spikes in deaths? Even if they can’t be tested, why aren’t we seeing it?