The COVID-19 pandemic is affecting each country differently. Healthcare structures, the government and the characteristics of a particular population create unique challenges that require a tailored response. Dr Mishal Khan and Professor Rashida Ferrand from the London School of Hygiene & Tropical Medicine explain key issues that Low- and Middle-income Countries (LMICs) are facing, and Dr Abdul Sesay from MRC Unit The Gambia at LSHTM describes how the Unit are utilising the latest genomic advancements to trace the virus.