The COVID-19 epidemic models described in the study incorporate factors such as demography and social contact patterns, health care availability and co-morbidities in lowand middle-income countries. Unlike in some high-income countries, mitigation strategies (defined as interventions that reduce transmission but R t remains above 1) would not be sufficient to prevent the overwhelming of health care systems in lower-income countries. Alternatively, suppression strategies (interventions reducing Rt to below 1) would result in a slower progress toward herd immunity, therefore would have to be kept in place for longer, causing wider health and economic consequences. The priority should be to increase the availability of oxygen support to mitigate the health impact alongside enhancing the capacity for surveillance and widescale testing to reduce the spread of infection and tailor appropriate NPIs. In the longer-term, ensuring equitable provision of pharmaceutical interventions to lower income countries once they are developed should be a global priority.